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Purpose To report the clinical outcomes of glaucoma management in patients with phacomatosis pigmentovascularis (PPV) treated over a period of 3 decades. Design Retrospective cohort study. Participants Fifty-five eyes of 38 patients (21 unilateral and 17 bilateral) with glaucoma in PPV managed at one institution between January 1990 and December 2019 with a minimum follow-up of 1 year. Methods Medical records of children with glaucoma in PPV were reviewed, and demographic and clinical data were collected. Surgical interventions included primary combined trabeculotomy-trabeculectomy (CTT), trabeculectomy with mitomycin C (MMC), and transscleral cyclophotocoagulation (TSCPC). Complete success was defined as intraocular pressure (IOP) ≥ 6 and ≤ 16 mmHg without medications and qualified success as IOP ≤ 16 mmHg with the use of up to 2 medications. Main Outcome Measures Intraocular pressure, best-corrected visual acuity (BCVA), corneal clarity, antiglaucoma medications at preoperative and postoperative visits (last visit), and complications. Results Median age was 4 months (range, 0.2–252 months) at the time of glaucoma surgery. Thirty-nine eyes (74%) had primary CTT, 10 eyes (19%) had trabeculectomy with MMC, and 4 eyes (7%) with advanced glaucoma had TSCPC. Two eyes (3.6%) received medical treatment. Preoperative IOP reduced from a mean of 25.7 ± 8.4 mmHg on 0.8 ± 0.6 medications to 14.6 ± 5.2 mmHg on 0.4 ± 0.5 medications (P 20/40. Four of 10 eyes that underwent trabeculectomy with MMC developed retinal detachment and were managed surgically; however, all of these eyes had poor visual outcomes. There was no incidence of bleb leakage, bleb-related infection, or endophthalmitis. Conclusions Combined trabeculotomy-trabeculectomy is safe and effective as a primary procedure for management of glaucoma in PPV. Trabeculectomy augmented with MMC as a second procedure was associated with a higher rate of complications.

PRECIS In this study, huge time delay was observed between first primary congenital glaucoma (PCG) symptom recognition by parents to ophthalmological diagnosis and this delay was unchanged over time. Bilateral affliction and mean presenting intraocular pressure (IOP) remained unaltered. PURPOSE To compare the trends in presentation of patients with PCG over 3 different time periods at 10-year intervals (1998, 2008, and 2018) managed by a single surgeon at one of the largest tertiary eye care centers in South India. METHODS Retrospective analysis of 313 eyes of 172 patients diagnosed to have PCG and treated at the L V Prasad Eye Institute (LVPEI) between January and December of the 3 specified years. Data collected included age at symptom recognition and at presentation, sex, affected eye, signs and symptoms, time between onset of symptoms and diagnosis (diagnostic delay), corneal clarity, and IOP. RESULTS Of the 172 patients, 48 (27.9%), 76 (44.2%), and 48 (27.9%) belonged to 1998, 2008, and 2018, respectively. Bilateral affliction (79% to 84%) was common and there was no sex predilection. The median age at recognition of first symptoms by caregivers/parents was 1 day (interquartile range, 1 to 30), and at diagnosis was 120 days (interquartile range, 30 to 378). Overall, presentation to LVPEI was delayed by >3 months in 80 (46.5%) children, and there was no statistically significant difference in the duration of delay over time (P=0.13). There was no significant difference in the mean presenting IOP over time (P>0.05). CONCLUSIONS We provide unique single center-based information of trends in the presentation of patients with PCG over 3 decades. Diagnostic delay was common, and a large number of characteristics of patients with PCG in South India have remained unchanged, particularly, age at onset and at diagnosis and laterality.

PURPOSE To evaluate the long-term visual and surgical outcomes, and associated risk factors for poor outcomes in patients with primary congenital glaucoma (PCG). METHODS Retrospective review of medical records of children who underwent combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C as the first surgical procedure by a single surgeon between January 1990 and December 2010. Success was defined as intraocular pressure (IOP)

Purpose The Caregiver's Congenital Glaucoma QoL (CarCGQoL) questionnaire was proposed as a measure of QoL of caregivers with children with primary congenital glaucoma (PCG). Support for its psychometric properties among other diagnostic groups is required for scores to be interpreted in the same manner across groups. Therefore we investigated the measurement properties and cross-diagnostic validity of the CarCGQoL questionnaire among caregivers of children with congenital cataract, retinopathy of prematurity (ROP), and blinding corneal disorders. Methods Eight hundred ninety-one caregivers (mean age, 28.3 years; 76% mothers) of children with congenital cataract (n = 407), ROP (n = 272), and blinding corneal disorders (n = 212) completed the CarCGQoL questionnaire. Rasch analysis was used to investigate the psychometric properties. Unidimensionality (by principal components analysis of residuals, PCA) was examined for each group and for pooled sample. Differential item functioning (DIF) was investigated to explore whether bias in responses to the questionnaire existed for certain subgroups as compared to the reference group (PCG). Results Across groups, six items necessitated removal because of misfit (two common and four uncommon), after which three different versions of the questionnaire emerged. Measurement precision was adequate for each group and for the pooled sample (0.80). Unidimensionality was observed, albeit with some DIF. Regardless of the level of QoL, caregivers in the pooled sample were more likely to endorse two items reflecting ability to face child's disease, and interest to pursue leisure activity, as compared with caregivers of children with PCG. Conclusions Care must be taken when data from the CarCGQoL questionnaire from different pediatric ocular conditions are pooled, given the presence of DIF between the reference group (PCG) and the pooled sample. Translational relevance When evaluating the impact of interventions on the caregiver's QoL using the CarCGQoL questionnaire in a pooled sample of pediatric ocular conditions, cross-diagnostic DIF must be taken into account.

Purpose Little is known about quality of life (QoL) and life satisfaction (LS) of treated primary congenital glaucoma (PCG) patients in adulthood. The purpose of this study was to assess the QoL and LS and their predictors among young adults treated for PCG during early childhood. Design Cross-sectional study. Participants Eighty-two participants with PCG (mean age, 22.5 years; standard deviation [SD], 4.6); 52% were male; 94% bilateral) recruited at L V Prasad Eye Institute. Methods Participants were asked to complete the 26-item World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaire (items related to satisfaction with general health, physical, psychological, social relations, and environmental aspects) and the 5-item Satisfaction with Life Scale (SWLS) in the clinic visit. Clinical data including visual acuity (VA) and visual fields (VFs) were collated from medical records. Rasch analysis was used to optimize the psychometric properties, with higher scores indicating a higher degree of QoL and LS, for both the questionnaires. Linear regression models were used to examine associations between overall QoL and LS (in separate models), and sociodemographic and clinical variables. Main Outcome Measures The QoL and LS were measured using Rasch-transformed scores from the WHOQOL-BREF questionnaire and SWLS, respectively. Results Response rate was 93%. The overall mean (SD) Rasch-scaled scores for QoL were 0.93 (1.11) and 0.87 (1.32) for environment domain and 0.41 (1.56) logits for LS. Better QoL was significantly related to rural residence and higher education in both univariable and multivariable analyses and explained 13% variance. Higher LS was significantly related to marital status, unilateral affliction, and higher education in univariable analyses. However, multivariable regression analysis showed that only marital status was independently associated with higher LS and explained 8.8% of variance. Clinical and treatment variables (VF, surgical interventions, medications) were not independent predictors of QoL/LS. Conclusions Our results suggest that QoL and LS of treated patients with PCG during adult life are generally good and appear to be driven by factors other than clinical indices. Educational achievement appears to be linked to better QoL and LS, and clinicians should emphasize the importance and need for education in the continued care of these patients.

Purpose To compare the visual functioning (VF) and vision-related QoL (VRQoL) of children 8–18 years old treated for primary congenital glaucoma (PCG) and secondary childhood glaucoma. Design Cross-sectional study. Methods A total of 309 children 8–18 years old treated for PCG and secondary childhood glaucoma between 2000 and 2010 by a single pediatric glaucoma specialist were prospectively enrolled at LV Prasad Eye Institute, Hyderabad, India. Children completed 2 questionnaires, the LV Prasad Functional Vision Questionnaire–II (LVP-FVQ-II), and the Impact of Vision Impairment-Children (IVI-C) questionnaire. Rasch-calibrated scores from both these questionnaires were used to compare the VF and VFQoL between the 2 groups. Results Mean ages of the children were 12.2 and 12.6 years in the PCG (53%, median age at diagnosis = 5 months) and secondary glaucoma groups (47%, median age at diagnosis = 3 years), respectively. A majority (80%) of children had bilateral glaucoma and underwent filtering surgery (83%). Mean better eye logMAR visual acuity (VA) was comparable between PCG and secondary childhood glaucoma groups (0.49 vs 0.52, respectively; P = 0.59). Children with PCG reported significantly better VF and VRQoL than secondary childhood glaucoma patients. Unadjusted and adjusted childhood glaucoma group comparisons revealed secondary childhood glaucoma to be associated with worse VF and VRQoL compared to PCG (difference for VF, −0.83; 95% confidence interval [CI], −1.34 to 0.31; P = 0.002; 0.39; 95% CI, 0.16–0.62; P = 0.001 for VRQoL). Conclusions Results show that children with treated PCG experience significantly better VF and VRQoL than those with secondary childhood glaucoma, despite comparable VA and IOP.

SIGNIFICANCE Mobile devices such as tablet computers have become widely available as mainstream devices and are also used in some schools, but there is an absence of robust information regarding the efficacy of any optical/electronic low vision device or tablet computer in supporting education of young people with low vision. PURPOSE A randomized controlled trial (RCT) is needed to measure the impact of tablet computers on education, specifically on independent access to educational material, in children and young people with low vision. We conducted a pilot RCT to determine the feasibility of conducting a full-scale trial. METHODS This was a randomized multicenter pilot trial across two sites in the United Kingdom and one site in India. Forty children and young people aged 10 to 18 years with low vision (best-corrected visual acuity for distance between

PURPOSE: To evaluate the health-related quality of life (HRQoL) of children operated for primary congenital glaucoma (PCG) using the Kidscreen-27 questionnaire. METHODS: A total of 121 children (mean age, 11.8 years; SD, 2.8 years; 51% males) with unilateral or bilateral PCG who underwent glaucoma surgery in infancy (mean duration since surgery, 10.2 years; [SD] 4.2 years) by a single surgeon at a tertiary eye care centre were administered the Kidscreen-27 questionnaire (self-or interviewer administered in a face-to-face interview) during their routine follow-up visit. We investigated the measurement properties of Kidscreen-27 questionnaire using Rasch analysis and generated interval-level estimates of HRQoL. The main outcome measure was HRQoL (i.e., Rasch-derived Kidscreen score). Multivariable linear regression analyses assessed the influence of socio-demographic and clinical variables on the HRQoL of children with PCG. RESULTS: Majority (83%) of the children had bilateral PCG and congenital type of the disease (79%). Mean presenting acuity (logMAR) in the better eye was 0.32 (SD, 0.36; median, 0.18). Rasch analysis of Kidscreen-27 questionnaire indicated need for minor modifications following which a psychometrically robust unidimensional 23-item Kidscreen questionnaire emerged. In multivariable model, age of the child was independently associated with a 32% (β = −0.24 [95% CI, −0.11, −0.36]) increase in the HRQoL score. CONCLUSIONS: Despite undergoing successful glaucoma surgery, children with PCG reported reduced HRQoL. Younger children with PCG are more likely to experience this lowered HRQoL and ophthalmologists will need to be alert to this. Efforts must be made to improve the HRQoL of children with PCG.

Purpose We developed and validated an instrument to measure the quality of life (QoL) of caregivers of children with primary congenital glaucoma (PCG): the Caregiver's Congenital Glaucoma Quality of Life (CarCGQoL) questionnaire. Methods A total of 70 caregivers of children with PCG under follow-up at a tertiary eye care center in India participated in a series of focus groups, and pre- and pilot testing phases in the development of the 45-item CarCGQoL questionnaire. Subsequently, this instrument was administered to 111 caregivers of children with PCG awaiting glaucoma surgery. Response to each item was rated on a four-category scale. Rasch analysis was used to validate the instrument's psychometric properties, such as unidimensionality (by principal components analysis [PCA] of residuals), item fit to model, measurement precision (by person separation [PS]), response category performance, differential item functioning (DIF), and targeting of items to participant's QoL. Results Categories required reorganization resulting in a shortened rating scale of 3 categories. The instrument showed misfit to the Rasch model and lacked unidimensionality. Deleting 15 items (obtained through PCA of residuals) restored unidimensionality, but additional items misfit, necessitating item reduction. In addition, 2 items showed DIF and were deleted. Finally, a 20-item CarCGQoL instrument showed good fit and unidimensionality. Targeting was good (0.69 logits) and PS was 2.51, indicating good measurement precision. Conclusions We have developed a psychometrically robust 20-item caregiver derived questionnaire, the CarCGQoL, that is a valid and reliable measure of QoL of caregivers of children with PCG. Given its brevity, it is quick and easy to administer in the clinic, and has potential for use as an outcome measure in clinical trials of treatment of PCG.

Previous reports, albeit isolated, of vision and ocular screening of athletes with intellectual disability participating in the Special Olympics, UK, indicated high rates of refractive error and ocular morbidity; however, there have been no reports of similar sports events for this population from India. This study set out to evaluate the vision profile and ocular characteristics of athletes with intellectual disability attending the Special Olympics Lions Club International Opening Eyes (SOLCIOE) event in 2012 in India.A cross-sectional study was conducted, where a protocol-based ophthalmological assessment was performed by trained optometrists at a tertiary eye care center.Overall, 172 athletes (mean age 18.6 years, 70% male) with intellectual disability participated, and 138 (80%) were able to cooperate for complete or nearly complete vision and ocular assessment. A total of 56 (32%) had never had a previous vision or ocular health status examination. A total of 46 (32%) presented with low vision (World Health Organization definition6/18 to 3/60 in the better eye), 21% needed a first or updated spectacle prescription, and 28% had significant ocular pathology as the cause of visual loss.The proportions of refractive errors and ocular disorders in athletes with intellectual disability attending the SOLCIOE program in South India are similar to those reported for able-bodied school-aged children in urban and rural India. Like that of their able-bodied peers, the visual needs of children with intellectual disability are also not adequately being met.

Introduction Low vision and blindness adversely affect education and independence of children and young people. New ‘assistive’ technologies such as tablet computers can display text in enlarged font, read text out to the user, allow speech input and conversion into typed text, offer document and spreadsheet processing and give access to wide sources of information such as the internet. Research on these devices in low vision has been limited to case series. Methods and analysis We will carry out a pilot randomised controlled trial (RCT) to assess the feasibility of a full RCT of assistive technologies for children/young people with low vision. We will recruit 40 students age 10–18 years in India and the UK, whom we will randomise 1:1 into two parallel groups. The active intervention will be Apple iPads; the control arm will be the local standard low-vision aid care. Primary outcomes will be acceptance/usage, accessibility of the device and trial feasibility measures (time to recruit children, lost to follow-up). Exploratory outcomes will be validated measures of vision-related quality of life for children/young people as well as validated measures of reading and educational outcomes. In addition, we will carry out semistructured interviews with the participants and their teachers. Ethics and dissemination NRES reference 15/NS/0068; dissemination is planned via healthcare and education sector conferences and publications, as well as via patient support organisations. Trial registration number NCT02798848; IRAS ID 179658, UCL reference 15/0570.

PURPOSE Visual impairment (VI) negatively affects quality of life (QoL). Utilities represent a way of measuring the QoL impact associated with a particular health state, like VI, and are also useful in economic evaluations of health care interventions. Utilities can be determined either directly or indirectly. Here we determine whether the Vision and Quality of Life Index, VisQoL (indirect approach), is acceptable to use in patients with VI in an urban setting in South India; whether the VisQoL utility values, derived from an Australian sample of both visually impaired and normally sighted participants, demonstrate agreement (if any) with direct utilities, determined by time trade-off (TTO), from visually impaired South Indian patients; and determine the relationship between utilities and self-reported visual disability. METHODS Three hundred forty-nine adults with VI were administered the two-item TTO item, six-item VisQoL, and the 16-item Andhra Pradesh Eye Disease-Visual Function Questionnaire (APEDS-VFQ) in a face-to-face interview. The VisQoL utilities were derived from the utility scoring algorithm. Rasch-scaled scores of the APEDS-VFQ were obtained using the conversion scores sheets. Agreement between TTO and utilities VisQoL was assessed using the Bland-Altman method. RESULTS All participants (response rate, 100%) completed the VisQoL as compared with 72% for the TTO. There was no statistically significant difference in the mean utilities from the two methods (0.65 ± 0.31 by TTO vs. 0.66 ± 0.27 by VisQoL, p = 0.67). However, the 95% limits of agreement on the Bland-Altman plot were wide (-0.65, 0.67), implying a lack of agreement between the methods. The VisQoL relates relatively strongly with APEDS-VFQ as compared with TTO (TTO vs. APEDS-VFQ, r = -0.23, VisQoL vs. APEDS-VFQ, r = -0.66, z = -6.70; p < 0.001 for both). Older participants, female, and those with less than 12 years of education had lower utilities. CONCLUSIONS The direct (TTO) and indirect (VisQoL) methods of utility evaluation tend to disagree in our patients with VI. Given the high completion rates of the VisQoL as compared with the TTO, the VisQoL may be a suitable alternative for utility assessment in an Indian population.

Previous Rasch analysis of the Andhra Pradesh Eye Disease Study-Visual Function Questionnaire (APEDS-VFQ) lacked comprehensiveness, specifically, dimensionality (whether it measures single/multiple constructs). Therefore, using the Rasch model this study provides a detailed assessment of psychometric properties of the APEDS-VFQ.A total of 351 visually impaired adults (mean age, 43.3 years) were verbally administered the APEDS-VFQ. Rasch analysis was used to assess the psychometric properties of the instrument.Participants could distinguish only three categories of difficulty, so response categories were reduced from five to three. A single item ("reading small prints in newspaper/magazines", infit mean square 1.54) misfit the model. The overall pattern of fit statistics for item and person measures suggested that the underlying construct (visual ability) is not unidimensional. When the items were grouped into subsets based on functional requirements (resolution, contrast sensitivity, illumination and peripheral vision) and separate person measures were estimated for each of these domains, the first principal component contained the visual ability and accounted for 72% of the variance. Item measure distributions could be divided into 18 strata, and item-separation reliability was 0.99. Person measures could be divided into three statistically distinct strata and the person-separation reliability was 0.81.The APEDS-VFQ is a precise measure of visual ability in visually impaired adults in India. Similar to other visual function questionnaires developed for the Western population, our results demonstrate that visual ability is a two-factor composite latent variable; one dimension heavily influences reading and the other most heavily influences peripheral vision (mobility).

Aim To investigate the psychometric properties of the three scales (general functioning, psychosocial impact, visual symptoms) of the Indian vision function questionnaire (INDeVFQ) using the Rasch measurement model. Methods 236 visually impaired patients referred to vision rehabilitation centres were administered the 33item INDeVFQ. Rasch analysis was used to investigate the scales for the following properties: precision by person separation (ie, discrimination between strata of patient ability, recommended minimum value 2.0), unidimensionality (ie, measurement of a single construct) and targeting (ie, matching of item difficulty to patient ability). Results Only the general functioning scale possessed adequate measurement precision (person separation 3.49). However, it lacked unidimensionality as some items did not contribute towards the measurement of a single construct indicating a secondary dimension. This comprised seven mobility items, which formed a separate valid subscale with good targeting (� 0.57 logits). Deleting these items restored unidimensionality but a misfitting item required removal. Following this the 13 items fit and were visual functioning related. However, targeting was suboptimal (� 1.13 logits). Conclusions The general functioning scale of the INDeVFQ consists of two separate unidimensional constructs: visual functioning and mobility. Both these Rasch scaled versions with good psychometric properties are effective tools for the assessment of visually impaired patients in India.

Purpose We assess parent-child agreement regarding child's health-related quality of life (HRQoL) in children operated for congenital glaucoma (CG). Methods A total of 121 children aged 8 to 18 years (mean age, 11.8 years) operated for CG (mean duration since surgery, 10.2 years) and their parents (mean age, 36.5 years) completed the child and parent versions of the Kidscreen-27 questionnaire, respectively. Psychometric properties of Kidscreen-27 were assessed using Rasch analysis, and child-parent agreement regarding child's HRQoL was investigated using the Bland-Altman limits of agreement (LoA) method. Results Minor modifications in the rating scale and deletion of few misfitting items resulted in a psychometrically robust Kidscreen-23 questionnaire. Average parental HRQoL score was higher than the child's own ratings, with a significant difference between their scores (mean ± standard deviation [SD] difference = 0.53 ± 2.58 logits, P = 0.02; lower LoA [95% CI], -4.52 [-5.31 to -3.72] and upper LoA [95% CI], 5.58 [4.79-6.38]). The range of child-parent agreement was wide and bidirectional, with parents tending to underestimate and overestimate their child's HRQoL. Younger children and girls showed greater discordance in their HRQoL with parental reports than adolescents and boys, respectively. Conclusions Discordance between CG child's self-report of HRQoL and parent's report indicate that both groups perceive the broader impact of living with CG very differently. Translational relevance The HRQoL as reported by the child with CG and by his/her parent should be viewed as being complementary, rather than interchangeable. Both assessments should be taken into account in clinical practice and research studies.

Purpose To examine the psychometric properties of the Visual Activities Questionnaire (VAQ) and each of its subscales in a modern cataract population using Rasch analysis and if flawed, to revise the VAQ and create a valid measure that maximizes its measurement properties. Setting Flinders Eye Centre, Flinders Medical Centre, Adelaide, Australia. Methods Patients with cataract in 1 or both eyes drawn from the surgical waiting list were mailed the 33-item VAQ for self-administration. The following were examined for the entire questionnaire and each subscale: whether items measured a single construct (unidimensionality), the behavior of response categories, the ability to differentiate between patients' visual abilities (person separation), matching of item difficulty to participant ability (targeting), and whether items function similarly across subgroups of participants (differential item functioning [DIF]). Results The VAQ was completed by 561 patients. Response categories were used as intended. The VAQ discriminated the visual ability of the population (person separation, 4.88) but had suboptimum targeting, misfitting items, significant multidimensionality, DIF, and 4 dysfunctional subscales. Elimination of items causing multidimensionality resulted in a reduced 13-item VAQ that met all validity criteria for satisfactory instrument performance. Only 1 valid subscale (peripheral vision) could be preserved in the 13-item VAQ. Conclusions The VAQ in its native form was multidimensional and contained subscales with poor psychometric properties. The revised unidimensional 13-item VAQ was more appropriate for application in cataract outcomes assessment. Ideally, more items should be included to improve the targeting of item difficulty to more able cataract patients.

Purpose: The Impact of Cataract Surgery (ICS) questionnaire was designed to assess cataract surgery outcomes. The aim of this study was to describe the psychometric properties of the ICS questionnaire using the Rasch model in a cataract population. Methods: Ninety-one patients waiting to undergo cataract surgery in the first or second eye at the Flinders Medical Centre, Adelaide, South Australia self-administered the four-item ICS questionnaire. Rasch analysis was performed to assess behaviour of response categories, ability to differentiate between participants’ visual abilities (person separation; minimum acceptable 2.0), if items measure a single underlying construct [i.e. unidimensionality assessed by fit statistics and further by principal components analysis (PCA)] and matching of item difficulty to participant ability (targeting; ideal

Purpose: The 5-item Cataract Symptom Score (CSS) was developed using classical test theory to determine appropriate timing for cataract surgery, its outcomes, and whether the symptoms included bother cataract patients. The purpose of this study was to investigate the psychometric properties of the 5-item CSS using Rasch analysis. Methods: Responses from 113 patients awaiting cataract surgery to the 5-item CSS (bothered by double or distorted vision, glare or halos, blurry vision, colors looking different and worsening of vision) were subjected to Rasch analysis. The use of response categories (threshold order), ability of CSS to discriminate between participants' severity of symptoms (person separation, recommended minimum value 2.0), matching of item difficulty to severity of symptoms (targeting), and ability of items to measure a single construct (unidimensionality) were investigated. Results: Participants used the response categories as intended. However person separation (1.74) was inadequate, suggest...

PurPose: The Adaptation to Age-related Vision Loss (AVL) scale was developed to measure the adjustment of older adults who are adapting to late-life vision loss. The purpose of this study was to assess whether the AVL scale satisfies the Rasch model in a cataract population. Methods: The 24-item AVL scale (18 negatively and 6 positively coded) was mailed to 436 cataract patients for self-administration whilst they were on the waiting list for cataract surgery at the Flinders Eye Centre, Adelaide, South Australia. Rasch analysis was performed to determine whether the items were measuring a single construct (unidimensionality) as examined with fit statistics and principal components analysis (PCA) of the residuals. The ability of the scale to distinguish between the levels of adaptation of the participants (person separation) was investigated, with a value ≥ 2.0 established as the minimum acceptable. results: The AVL scale was unable to differentiate sufficiently between participants’ levels of adaptation, indicating poor person separation. One item did not fit the construct, causing misfit. Furthermore, the five positively worded items did not appear either to measure the same construct as other items, resulting in lack of unidimensionality evidenced by PCA. Following the deletion of these items, the AVL scale was one-dimensional but a single item continued to misfit, so it had to be deleted, resulting in an 18-item AVL scale. Even so, the discriminating abilities of the scale continued to be poor. ConClusions: The AVL scale is not an appropriate measure of adaptation to vision loss in a cataract population. (J Optom 2009;2:142-147 ©2009 Spanish Council of Optometry)

People suffering from low vision, a condition caused by a variety of eye-related diseases and/or disorders, find their ability to read greatly improved when text is magnified between 2 and 6 times. Assistive devices currently on the market are either geared towards reading text far away (∼20 ft.) or very near (∼2 ft.). This is a problem especially for students suffering from low vision, as they struggle to flip their focus between the chalkboard (far-field) and their notes (near- field). A solution to this problem is of high interest to eye care facilities in the developing world - no devices currently exist that have the aforementioned capabilities at an accessible price point. Through consultation with specialists at L.V. Prasad Eye Institute in India, the authors propose, design and demonstrate a device that fills this need, directed primarily at the Indian market. The device utilizes available hardware technologies to electronically capture video ahead of the user and zoom and display the image in real-time on LCD screens mounted in front of the user's eyes. This design is integrated as a wearable system in a glasses form-factor.

PURPOSE To evaluate the outcomes of multidisciplinary low vision rehabilitation (LVR) in adults with low vision (LV) in India using the Veterans Affairs Low Vision Visual Functioning Questionnaire (VA LV VFQ-48) and the Impact of Vision Impairment (IVI) questionnaire. METHODS Consecutive adults with LV referred for the first time to the Centre for Sight Enhancement were administered the 28-item IVI and VA LV VFQ-48 before and after LVR (4 months). Rasch-scaled scores were generated for the IVI and the VA LV VFQ-48 along with each of their subscales at both the time points. Effect size (ES) was calculated using Cohen's d coefficient. RESULTS Two hundred fifty-five patients completed the LVR program. Following LVR, the linear measures revealed significant improvements in vision-related quality of life (VRQoL) using the IVI at follow-up (P < 0.0001), with large ES for reading and accessing information (ES = 1.0) and relatively moderate ES for overall IVI (ES = 0.63) and mobility subscale (ES = 0.53). No significant improvement was found on emotional well-being subscale (ES = 0.18; P = 0.06). Similarly, significant improvements in VRQoL (P < 0.0001) were found for the VA LV VFQ-48 at follow-up, albeit moderate ES for the overall visual ability (ES = -0.67) and its subscales (reading [ES = -0.72], mobility [ES = -0.45], visual information [ES = -0.47), visual motor [ES = -0.54]). CONCLUSIONS Regardless of the instrument used for assessment, our multidisciplinary LVR program resulted in statistically significant improvements in visual functioning and VRQoL of those adults with LV deemed appropriate for intervention (dropout rates were high); however, the improvements were modest, and the clinical relevance of these small improvements may be limited. Nonetheless, further studies should attempt to increase the completion rates in order to draw strong inferences.

Purpose The aim of the study was (1) to determine the need for spectacles in children in Southern India with coloboma, microphthalmos and microcornea, (2) to describe their refractive errors and (3) to assess their needs for low vision aids (LVAs). Methods Children with congenital eye anomalies were recruited from special education for the blind, schools for the mentally handicapped, community-based rehabilitation programmes and hospital records in Andhra Pradesh, India. All those with at least light perception vision (PU in one eye and who had navigational vision were refracted. Those whose distance vision in their better eye improved with refraction were prescribed spectacles. Those unable to read NI0 were assessed for LVAs for near. Those with distance visual acuity of < 6/18 in the better eye were assessed for telescopes to aid distance vision. Results Ninety-nine children with coloboma, microcornea or microphthalmos had functional vision. Eight unilateral cases were excluded. Ninety-one bilateral cases were refracted and assessed for LVAs. The vision in 52 children (57%) improved in the better- seeing eye by 1 or more lines of Snellen acuity with spectacles. Spectacles were prescribed most frequently for myopia associated with choroidal coloboma. After refraction, all 19 children with a visual acuity of 6/18 or better could read NI0, and 43 of the 72 children (60%) with a visual acuity of

PURPOSE: To evaluate the extent of visual recovery after multi-disciplinary approach of treatment in serious ocular injuries; to determine the prognostic factors associated with poor final visual outcome and suggest adequate precautionary measures. METHODS: A retrospective analysis of 325 consecutive patients with direct ocular trauma who were examined and treated at a tertiary eye care centre in South India over a 3-year period was undertaken. RESULTS: Males (86.8%) outnumbered the females (13.2%) and children ( Language: en

The authors describe a case of an endocapsular hematoma that occurred in a 69-year-old Pseudophakic diabetic male following mitomycin C (MMC) augmented trabeculectomy for neovascular glaucoma (NVG). The clinical course of the patient is described, and the unique features of this case are presented and discussed. The endocapsular hematoma absorbed in 6 weeks with conservative management. The patient regained the preoperative visual acuity of 20/30, and his intraocular pressure was controlled without any glaucoma medication. The iris neovascularization regressed. This case is the first report of an endocapsular hematoma following glaucoma filtering surgery in a Pseudophakic eye with neovascular glaucoma. [Ophthalmic Surg and Lasers 1999;30:389-393.]

* BACKGROUND AND OBJECTIVE: To evaluate long-term intraocular pressure (1OP) control and visual outcome of patients with phacolytic glaucoma. * PATIENTS AND METHODS: Forty-five consecutive eyes of 45 patients with phacolytic glaucoma operated on between January 1990 and December 1995 and who had completed at least 1 year of followup were included in the study. Of the 45 eyes, 17 eyes underwent extracapsular cataract extraction (ECCE) with primary posterior chamber intraocular lens (PC IOL) implantation (group 1). The rest of the eyes (n = 28) underwent only ECCE (group 2) in view of satisfactory aphakic vision in the contralateral eye. Preoperative IOP, visual acuity, and anterior segment appearance were compared with postoperative data. * RESULTS: IOP was controlled (IOP < 21 mm Hg) in all of the patients without any antiglaucoma medication, with a mean follow-up of 29.11 ± 16.25 months (range 12 to 60) and 43.2 ± 21.5 (12 to 78) months in groups 1 and 2, respectively. The IOP remained controlled without antiglaucoma medication even in the patients where the desired visual recovery was not obtained due to glaucomatous disc damage because of delayed presentation (2 to 3 weeks or more). A visual acuity of 20/40 or better was achieved in 76.5% and 60.7% in groups 1 and 2, respectively. Eighteen of the 45 patients initially presented with light perception without projection. Eight of these 1 8 patients (44%) regained a visual acuity of 20/40 or better. There was no significant intraoperative and postoperative complication in any patient. * CONCLUSIONS: ECCE with or without primary PC IOL implantation is safe and curative in patients with phacolytic glaucoma. The addition of trabeculectomy to cataract extraction seems to be superfluous in the control of IOP in patients with phacolytic glaucoma operated on within 2 to 3 weeks of the onset of symptoms. Light perception without projection is not a contraindication for cataract surgery in phacolytic glaucoma. [Ophthalmic Surg Lasers 1998;29:880-889.]

Purpose To determine the visual success outcomes following treatment in an urban private eye hospital in India. Methods A retrospective survey was done of 4122 consecutive files of fee-paying patients admitted to a private eye hospital in Hyderabad during a 3-month period in 1996. Data obtained a minimum of 4 months after completion of treatment included age, sex, diagnosis and distance visual acuity in the best eye. Results After completion of treatment 86.5% of patients had normal vision, 10.9% had low vision and 2.5% were blind. Of the people with low vision or blindness after treatment, 81.7% had a best corrected visual acuity of between 6/18 and 6/60. The 4 most common causes of low vision after treatment were unoperated cataract (20.4%), glaucoma (13.3%), diabetic retinopathy (12.4%) and retinitis pigmentosa (10.2%). Conclusion The visual success rates in an urban Indian private eye hospital appear high with nearly 90% of patients achieving normal vision after the completion of treatment.

A healthy child was brought to our emergency department 2 h after birth with a diagnosis of suspected unilateral congenital glaucoma of the left eye. There was a history of forceps assisted delivery. Examination showed conjunctival chemosis, congestion and corneal oedema, more prominent centrally and paracentral vertical fold across the diameter of the cornea (figure 1). The right …

We determined if the Impact of Vision Impairment (IVI) is a valid questionnaire to measure the vision-related quality of life (VRQoL) in keratoconus patients, and investigated if the VRQoL varied with disease severity in this sample.WE RECRUITED 160 CONSECUTIVE BILATERAL KERATOCONUS PATIENTS (MEAN AGE 23.3 YEARS, 63% MALE) FROM AN INDIAN TERTIARY EYE CARE CENTER. PARTICIPANTS UNDERWENT A CLINICAL EXAMINATION AND COMPLETED THE IVI. PARTICIPANTS WERE DIVIDED INTO THREE GROUPS BASED ON THE AVERAGE OF THE STEEP KERATOMETRY (K) READINGS: mild (average Sim K45 diopters [D]), moderate (average Sim K 45-52 D), and severe (average Sim K52 D). Rasch analysis was used to validate the IVI and the VRQoL scores thus obtained were compared across the disease groups.THE MAJORITY (63%) OF PATIENTS HAD SEVERE, WHILE THE REMAINDER (37%) HAD MODERATE KERATOCONUS. RASCH ANALYSIS DEMONSTRATED THE VALIDITY OF THE IVI TO ASSESS VRQOL THROUGH TWO SUBSCALES: vision-specific functioning (VF) and emotional well-being (EWB). There was no significant difference in VF (mean change -0.16, P = 0.55) and EWB scores (mean change -0.32, P = 0.23) between moderate and severe keratoconus groups.The revised IVI subscales have interval-level measurement properties, which support their suitability to measure VRQoL in this keratoconus sample. Patients with moderate or severe keratoconus had similar, but higher VRQoL scores as assessed by the revised IVI subscales, indicating lack of impact of the disease on their VRQoL. However, this does not exclude the possibility of finding an impact in other populations.

PURPOSE To evaluate the impact of glaucoma on visual functioning in Indians. METHODS Patients attending the glaucoma service who had undergone a comprehensive glaucoma evaluation were recruited. Better mean deviation (MD, using Humphrey Field Analyzer program 24-2) between two eyes was used to classify participants into mild, moderate, and severe visual field (VF) loss groups. Participants were administered the Glaucoma Quality of Life-15 (GQL-15) questionnaire. Rasch analysis was used to validate the GQL-15 and its four subscales. Linear regression was used to determine associations between GQL-15 scores and VF loss after adjusting for sociodemographic variables. RESULTS A total of 198 patients (mean age ± SD, 59.8 ± 12.3 years; 67% male) were recruited. Participants with severe VF loss (39%) followed by mild loss (35%) comprised the largest group. Rasch analysis resulted in a 10-item reliable and valid questionnaire: the Glaucoma Activity Limitation-10 (GAL-10). Although a single subscale, "peripheral vision," met requirements of the Rasch model, it could not be preserved in the GAL-10. In multivariate analyses, the middle-income group (compared with higher income) and severe VF-loss (compared with mild VF-loss) participants reported significantly poorer functioning on GAL-10 ([β = 0.84; 95% confidence interval (CI), 0.16-1.52; P = 0.02] and [β = 1.19; 95% CI, 0.61-1.78; P < 0.000], respectively). None of these associations were, however, clinically significant. CONCLUSIONS Glaucoma patients in India, especially those with severe VF loss, face significant challenges in performing daily tasks and in mobility. It is important to prevent progression such that activity limitation is minimized in glaucoma patients.

PURPOSE: To determine whether the Visual Symptoms and Quality of Life Questionnaire (VSQ), which was developed to be sensitive to second-eye cataract surgery, has satisfactory psychometric properties and, if so, to examine first-eye, second-eye, and bilateral cataract surgery outcomes. SETTING: Ophthalmology Clinic, Flinders Medical Centre, Adelaide, Australia. DESIGN: Cohort study. METHODS: The 26-item VSQ was self-administered by cataract patients before and after cataract surgery and by those on the cataract surgery waiting list. The VSQ was revised by Rasch analysis using preoperative questionnaire data. The surgical outcome measures were logMAR visual acuities and the Rasch-refined VSQ. RESULTS: The VSQ was self-administered by 92 patients before and after surgery (25 first eye, 38 second eye, and 29 bilateral) and by 147 on the waiting list. The preoperative visual acuity (surgical eye) was similar across groups. Cataract surgery improved visual acuities in all groups; the mean better-seeing eye visual acuity was significantly better (by 2 lines) in second and bilateral surgery patients than in first-eye surgery patients. Preoperative visual disability was significantly higher in patients awaiting cataract surgery in both eyes than in those awaiting second-eye surgery. Postoperatively, visual disability decreased significantly in all groups (first eye, 1.66 logits; second eye, 1.52 logits; bilateral, 2.58 logits). However, a floor effect limited the measurement of visual disability after cataract surgery. CONCLUSIONS: The revised visual disability scale of the VSQ measured a reduction in visual disability after first, second, and bilateral cataract surgery. However, the VSQ could not measure lower levels of visual disability, suggesting better questionnaires are required. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

This case documents unilateral congenital glaucoma associated with congenital lower lid entropion. A 2-year-old female infant was referred for evaluation and treatment of right-side buphthalmos caused by congenital glaucoma associated with bilateral congenital lower lid entropion that was prominent on the right side and present at birth. Examination disclosed a lower eyelid entropion of the right side that was treated surgically by reinserting the disinserted retractor aponeurosis to anterior inferior tarsal border. After three weeks, the patient was successfully treated with primary combined trabeculotomy-trabeculectomy for congenital glaucoma. The entropion of the left lower lid was asymptomatic and did not require any surgery. Buphthalmos caused by congenital glaucoma may be associated with congenital lower lid entropion and the association may be causal or coincidental. [Ophthalmic Surg Lasers 2001;32:149-151]

Purpose To investigate the responsiveness of 16 questionnaires used in cataract surgery outcomes. Design Prospective, observational study. Participants Patients at the Ophthalmology Eye Clinic, Flinders Medical Centre, Adelaide, Australia, and 1 matched eye clinic in Sweden. Methods Sixteen Rasch-scaled cataract surgery questionnaires were completed before and 6 months after surgery. These were: the Cataract Symptom Scale, 6 versions of the National Eye Institute Visual Function Questionnaire, the Quality of Life and Vision Function Questionnaire, the Cataract TyPE Specification, the Visual Activities Questionnaire, the Visual Disability Assessment (VDA), the Visual Function and Quality of Life questionnaire, the Visual Function Index, Catquest-9SF, the Visual Symptoms and Quality of Life questionnaire, and the Cataract Outcomes Questionnaire. Responsiveness was calculated with the effect size (ES) statistic (change in questionnaire score divided by pooled standard deviation of the preoperative and postoperative scores). Main Outcome Measures Questionnaire responsiveness to cataract surgery (ability to detect clinically important change). Results All 16 questionnaires and their subscales were responsive to cataract surgery, with visual functioning scales being more responsive than socioemotional scales and some subscales being less responsive. The largest ES was for the Catquest-9SF (1.45; 95% confidence interval [CI], 1.22–1.67), which was the only instrument with a mean and 95% CI of more than 1.0 (very large ES). Three measures had very large ESs and 95% CIs of more than 0.80 (large ES): the VDA (activity limitations and subscale) and the Cataract Outcomes Questionnaire, although their 95% CIs overlapped with a number of other instruments. Conclusions The Catquest-9SF is short and highly responsive to cataract surgery, and so is ideal for measuring visual functioning outcomes. Other instruments may be preferred to measure different constructs. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Aim The Visual Disability Assessment (VDA), a questionnaire for measuring the impact of cataract on visual functioning, was developed using classical test theory. Since this approach is limited, our aim was to further investigate the psychometric properties of the VDA using Rasch analysis. Methods 613 patients from the Flinders Medical Centre cataract surgery self-administered the VDA. Psychometric properties investigated for the overall VDA and each subscale included: measurement of a single construct (unidimensionality), item fit to the construct, reliable discrimination between strata of patient ability (person separation) and targeting of item difficulty to person ability. Results The VDA discriminated five strata of patient ability. However, seven mobility items constituted a second dimension and formed a valid separate scale. Sequestration of these items resulted in a unidimensional 11-item measure of activity limitation. Both the mobility and activity limitation scales had acceptable person separation and neither contained misfitting items. Targeting was suboptimal for mobility (−2.12 logits) but good for activity limitation (−0.72). The subscales also satisfied the requirements of the Rasch measurement model. Conclusions The Rasch-scaled VDA effectively measures two separate constructs: mobility and activity limitation (with two subscales). Its good psychometric properties make it suitable for measuring cataract surgery outcomes.

PURPOSE: To determine which version of the Visual Function Index-14 (VF-14) most precisely measured cataract surgery outcomes, rescale the VF-14 using Rasch analysis, and create a short-form version for comparison. SETTING: Flinders Medical Centre, Adelaide, South Australia, Australia. METHODS: In this cohort study incorporating questionnaire development, participants were drawn from the cataract surgery waiting list at Flinders Medical Centre. There were 2 cohorts: a preoperative cohort used for questionnaire development and an outcomes cohort. All patients had cataract surgery by phacoemulsification with intraocular lens implantation. Rasch analysis was used to refine the VF-14 into valid long-form (VF-11R) and short-form (VF-8R) versions. The ability of 8 versions (original; 2 proposed versions; 5 previously proposed versions) of the VF-14 to discriminate cataract surgery outcomes was compared with that of the standard VF-14 using the relative precision method. RESULTS: The preoperative cohort comprised 210 patients and the outcomes cohort, 51 patients. Large gains in visual functioning occurred with cataract surgery, and these were detectable with all versions of the VF-14. The largest gain in precision, 125% (relative precision. 2.25), occurred for VF-8R. Short forms that were not Rasch scaled showed gains in precision, from 23% to 80%. The VF-8R also showed the largest gains in precision in 2 subgroups: with ocular comorbidity (relative precision, 2.14) and without ocular comorbidity (relative precision, 2.48). CONCLUSIONS: Results show an unequivocal advantage to using Rasch-scaled scores for assessing cataract surgery outcomes. The 8-item, Rasch-scaled VF-8R appears ideally suited for measuring cataract surgery outcomes given its high precision and short test time. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Purpose To determine, by using Rasch analysis, whether the McMonnies questionnaire possesses the properties of a measure and whether screening for dry eye syndromes (DESs) can be enhanced by using different scoring approaches. Methods The questionnaire was self-administered by 43 female Sjogren syndrome patients (>45 years) recruited from a specialized rheumatology clinic and 140 age-matched control subjects. Data were scaled by using Rasch analysis and were assessed for response category behavior and ability to reliably discriminate between severity of the participant's dry eye symptoms (i.e., person separation reliability; minimum acceptable value, 0.80). Standard summary statistics of screening performance were calculated for raw and Rasch-scaled scores from receiver-operating characteristic analysis including area under the curve (AUC). Best predictors (i.e., questions) from a discriminant analysis were used to calculate a discriminant function for both Rasch-scaled and raw scores. Results Response categories were not used as intended, necessitating a collapse of categories. Person separation reliability was inadequate (0.75). A Rasch-scaled discriminant cutoff score of -2.29 logits from seven items provided an AUC of 0.99 with 95% sensitivity. However, discriminant raw score from modification in the scoring of a question (e.g., use of medications), used as one rather than multiple questions, provided an AUC (0.97) that was not significantly different (z = 1.11, P = 0.27), with 98% sensitivity, and required only two questions. Conclusions In this population, the McMonnies questionnaire does not function as a measure. However, various scoring methods can be used to efficiently screen for DES.

Background: The Catquest questionnaire was developed using traditional methodology to enable cataract surgery outcomes assessment in European countries. Recently, it has been validated using Rasch analysis in a Swedish population resulting in the Catquest-9SF. The aim of the present study was to assess the performance of the Catquest and the Catquest-9SF questionnaires using Rasch analysis in Australian cataract patients. Methods: A total of 217 cataract patients awaiting surgery at Flinders Medical Centre, Adelaide, South Australia self-administered the Catquest questionnaire. This is a 19-item instrument containing frequency, difficulty, symptoms and global rating items. Rasch analysis was undertaken to assess the unidimensionality (whether all the items are measuring a single underlying construct using principal components analysis or PCA), person separation (ability of the questionnaire to distinguish between strata of patient ability) and targeting of item difficulty to person ability. Results: Similar to the previous validation study, the original Catquest questionnaire required revision because of misfit and multidimensionality necessitating removal of the frequency items. The revised version was similar to the Catquest-9SF although an extra driving item was a valid optional inclusion. The Catquest-9SF performed well in the Australian cohort satisfying all criteria for valid measurement including unidimensionality. However, targeting of item difficulty to person ability was marginally worse compared with the Swedish cataract population indicating the Australian cataract patients present for surgery at lower levels of visual disability. Conclusions: The Catquest-9SF is a reliable and valid measure of visual disability in the Australian cataract population.

Aim: Previous psychometric evaluation of the Cataract Symptom Scale (CSS) focused on classic assessments of reliability and validity. The aim was to investigate the psychometric properties of the CSS using the Rasch measurement model. Methods: 243 patients drawn from the Flinders Eye Centre cataract surgery waiting-list self-administered the CSS. Rasch analysis was used to investigate the following properties of the CSS: measurement a single construct (unidimensionality), discrimination between strata of patient ability (person separation) and targeting of item difficulty to person ability. Results: The CSS discriminated between four strata of patients. However, some items did not contribute towards measurement of a single construct, indicating a secondary dimension. This comprised three mobility items, which formed a separate valid subscale. Elimination of these items resulted in the CSS being a unidimensional measure. However, further item deletion was required, as symptoms items did not measure the same construct. The resultant nine-item measure was unidimensional. Conclusions: The CSS consists of two separate unidimensional constructs: mobility and visual disability. The reduced nine-item measure has good psychometric properties and is unidimensional. The CSS is essentially a measure of visual disability, and not cataract symptoms as it is claimed to be.

The Distance Vision Scale (DVS) is a self-assessment of visual acuity (VA). Like VA testing in which letter reading becomes progressively difficult through the test, DVS questions have a hierarchy of difficulty (Guttman scale). The aims were to determine whether the DVS fulfills Guttman scaling criteria and to test the relationship between DVS score and VA in a cataract population.Responses of 113 participants to the DVS were subjected to Guttman analysis. Standard criteria of scalability were evaluated that included the coefficient of reproducibility (CR), minimal marginal reproducibility (MMR), and coefficient of scalability (CS). The relationship between total item score and binocular visual acuity was determined.Five participants were excluded because of missing data. Regularity in the banding pattern of the scalogram of the 108 participants was suggestive of a deterministic Guttman scale. Analyses showed that DVS satisfies the criteria for classification as a valid unidimensional and cumulative scale, as CS (0.93), CR (0.99), and MMR (0.85) values fall within the desired range. The statistically significant correlation between the total item score and binocular VA was 0.24.The DVS fits the Guttman scale, supporting the deterministic model underlying the scale. It correlates poorly with VA, suggesting it taps aspects of visual performance and other issues beyond high-contrast VA. The DVS could be used as an outcome measure to evaluate change over time and could be used to set achievable treatment objectives because of its hierarchical properties.

PURPOSE: To assess the psychometric properties of the Cataract TyPE Specification (Spec) questionnaire using the Rasch model. SETTING: Flinders Medical Centre, Adelaide, Australia. METHODS: The 12-item Cataract TyPE Spec questionnaire was self-administered to patients drawn from the cataract surgery waiting list. The questionnaire and its 5 subscales were assessed for fit to the Rasch model. Response category performance, item-fit targeting, unidimensionality (using principal components analysis), and differential item functioning were assessed. A shortened version (11 items) was tested for criterion validity by determining correlation with a global rating of vision question. RESULTS: Two hundred ninety-four patients responded to the questionnaire. The response categories for each question functioned as intended. Person-separation reliability was high (0.90). Deletion of 1 misfitting item (nighttime driving) improved overall model fit. The principal components analysis of the residuals demonstrated unidimensionality for the 11-item Cataract TyPE Spec and 2 subscales. However, items were targeted to a less able population. Only 2 subscales (near vision and glare) were valid. There was a good statistically significant correlation between the Likert-scored global rating of vision and the Rasch-scaled Cataract TyPE Spec score (r Z 0.66, P

To evaluate the change in visual functioning (VF) using the L. V. Prasad-Functional Vision Questionnaire II (LVP-FVQ II) following multidisciplinary low vision rehabilitation (LVR) services in children with low vision (LV).Children with LV referred for the first time to the Centre for Sight Enhancement were administered the LVP-FVQ II at baseline and at 3 to 4 months' follow-up to assess the outcomes of LVR. Participants' responses to the LVP-FVQ II at baseline and follow-up were transformed into interval-level estimates of VF using Rasch analysis. Cohen's d values (effect size) were used to estimate the magnitude of change in VF.A total of 183 participants completed the rehabilitation (mean age, 11.9 years; male, 57%). More than one-half of the participants had retinal disorders (55%) and most were moderately visually impaired (20/60-20/200, 76.5%). Using the LVP-FVQ II, significant improvement in VF after rehabilitation was recorded (P0.0001) and the increase in VF (SD) was 1.20 (1.82) logits. Using Cohen's d, the magnitude of the improvement in LVR intervention at follow-up was found to be 0.75, indicating nearly large treatment effect.Ours is the first study to provide strong evidence that LVR services result in nearly large and significant improvements in the overall VF in children with LV, regardless of the cause of LV. These results should encourage eye care professionals to refer children with LV to LVR services. Further investigation is needed to determine if the improvement in VF can be sustained over a longer duration (4 months).

To determine the surgical outcome after initial surgery in children with primary developmental glaucoma (PDG).Six hundred and twenty-four eyes of 360 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) for PDG from January 1990 to June 2004 were studied. The main outcome measures were pre- and postoperative intraocular pressures (IOPs), corneal clarity, visual acuities, refractive errors, success rate, time of surgical failure, complications, and factors associated with poor outcome.IOP reduced from 28.1+/-7.5 to 14.9+/-5.9 mmHg (P0.0001). Probability of success (IOP21 mmHg) was 85.2, 80.4, 77.2, 72.6, 66.2, and 57.5% at first, second, third, fourth, fifth, and sixth years, respectively (Kaplan-Meier analysis). The mean follow-up period was 20.3+/-25.6 months (median, 6 months). Preoperatively, 243 eyes (67.5%) had significant corneal oedema. Postoperatively, normal corneal transparency was achieved in 162 eyes (46.0%). Data on Snellen visual acuity were available in 100 patients (27.8%). At the final follow-up visit, 42 patients (42.0%) had normal visual acuity (or=20/60). Myopia (mean spherical equivalent, 6.1 D) was the most common (75.0%) refractive error. In multivariate analyses, failure increased by three-fold in the presence of preoperative IOP35 mmHg (hazards ratio (HR)=3.12; 95% confidence interval (CI), 1.4-6.7) and two-fold in cases with a history of prior glaucoma surgery (HR=2.57; 95% CI, 1.1-6.0). There were no major intraoperative complications, bleb-related infection, or endophthalmitis.This series shows that prolonged IOP control can be achieved in patients with PDG and 42% of the patients gained normal visual acuity.

To determine the visual outcomes and surgical and anesthetic complication rates of patients with newborn glaucoma operated within 1 month of age.Retrospective, consecutive, noncomparative case series.All children with newborn glaucoma who underwent surgery between January 1990 and December 2000 were included.The medical records of 25 consecutive patients (47 eyes) who underwent primary combined trabeculotomy and trabeculectomy either bilaterally in a single session or unilaterally were reviewed retrospectively. Outcomes were evaluated using Kaplan-Meier survival analysis.Clinical outcome assessment included corneal clarity, intraocular pressure (IOP), bleb characteristics, visual acuity, refractive errors, and identification of surgical and anesthetic complications.The mean follow-up was 3.1+/-1.8 years (range, 9.5 months-7.4 years). The mean preoperative IOP was 26.9+/-5.2 mmHg (range, 14-42 mmHg). At the final follow-up visit, the mean IOP was 14.5+/-3.8 mmHg (range, 8-28 mmHg). The percentage reduction in IOP was 43.3+/-21.5 (P0.0001). Twelve-, 24-, and 36-month survival rates for complete success for IOP control were 89.4%, 83.6%, and 71.7%, respectively, which were maintained for 7 years of follow-up. After surgery, complete clearance of corneal edema was achieved in 66% of the eyes. Data on visual acuity was available for 19 patients. Final best spectacle-corrected visual acuity was 20/40 or better in the better eye in 5 patients (26.3%), 7 patients (36.8%) obtained 20/60 or better in the better eye, 8 patients (42.1%) achieved final visual acuity of less than 20/60 to 20/200 in the better eye (low vision), and four patients obtained less than 20/400 visual acuity in the better eye (blind) according to World Health Organization criteria. However, there was no eye with absent perception of light in the better eye. Myopia (mean spherical equivalent, 4.6+/-3.2 diopters) was the most common refractive error, present in approximately half of the eyes (n = 23; 53.8%). There were no significant intraoperative or postoperative complications in any patient. Anesthesia-related complications developed in 2 patients; however, they were resuscitated successfully.Primary combined trabeculotomy-trabeculectomy offers a viable surgical option in infants that have cloudy corneas at birth as a result of congenital glaucoma. It is associated with a favorable visual outcome and a low rate of anesthetic complications in an Indian population.

Glaucoma is the leading cause of irreversible blindness worldwide after cataract and accounts for 10% of the world's blind.1 Although patients with acute angle closure glaucoma are symptomatic, those with other forms of glaucoma (at least in the early stages) usually do not experience many symptoms, thereby, resulting in the disease often going unnoticed with possible progression. In some cases, patients with fluctuating levels of intraocular pressure may experience blurred vision and see haloes around lights. The Glaucoma Symptom Scale (GSS) was developed to assess ophthalmic symptoms experienced by patients with glaucoma.2 The GSS comprises 10 ocular symptoms, of which six are non-visual and four are visual. The non-visual symptoms include ‘burning/smarting/stinging’, ‘tearing’, ‘dryness’, ‘itching’, ‘soreness/tiredness’, and ‘feeling of something in the eye’. The visual symptoms include ‘blurry/dim vision’, ‘hard to see in daylight’, ‘hard to see in darkness’, and ‘halos around lights’. The GSS is unique in that it assesses symptoms as compared with visual functioning by other glaucoma-specific questionnaires. Like most questionnaires in ophthalmology, the GSS was also developed using traditional psychometric methods, that is, the classical test theory (CTT).3 The limitations of CTT have been well acknowledged. A major shortcoming of CTT pertains to its scoring assumptions: Likert or summary scoring in which the scores are calculated from …

BACKGROUND: Depression and anxiety are two common normal responses to a chronic disease such as glaucoma. This study analysed the measurement properties of the depression screening instrument - Patient Health Questionnaire-9 (PHQ-9) using Rasch analysis to determine if it can be used as a measure. METHODS: In this hospital-based cross-sectional study, the PHQ-9 was administered to primary glaucoma adults attending a glaucoma clinic of a tertiary eye care centre, South India. All patients underwent a comprehensive clinical evaluation. Patient demographics and sub-type of glaucoma were abstracted from the medical record. Rasch analysis was used to investigate the following properties of the PHQ-9: behaviour of the response categories, measurement precision (assessed using person separation reliability, PSR; minimum recommended value 0.80), unidimensionality (assessed using item fit [0.7-1.3] and principal components analysis of residuals), and targeting. RESULTS: 198 patients (mean age ± standard deviation = 59.83±12.34 years; 67% male) were included. The native PHQ-9 did not fit the Rasch model. The response categories showed disordered thresholds which became ordered after category reorganization. Measurement precision was below acceptable limits (0.62) and targeting was sub-optimal (-1.27 logits). Four items misfit that were deleted iteratively following which a set of five items fit the Rasch model. However measurement precision failed to improve and targeting worsened further (-1.62 logits). CONCLUSIONS: The PHQ-9, in its present form, provides suboptimal assessment of depression in patients with glaucoma in India. Therefore, there is a need to develop a new depression instrument for our glaucoma population. A superior strategy would be to use the item bank for depression but this will also need to be validated in glaucoma patients before deciding its utility.

Purpose We evaluated the utility values (UVs), using the time trade off (TTO) technique, associated with primary glaucoma and varying degrees of visual field (VF) loss. Methods In this cross-sectional study, 198 adults (mean age, 59.8 years) with primary glaucoma were recruited from the glaucoma clinic of a tertiary center in Hyderabad, South India. Each patient underwent comprehensive glaucoma evaluation, and completed the utility (TTO) and Glaucoma Quality of Life-15 questionnaires (Rasch version, Glaucoma Activity Limitation [GAL]-10). Better mean deviation (MD, using Humphrey Field Analyzer program 24-2) between two eyes was used to classify participants into mild, moderate, and severe VF loss groups. Utilities (range, 0.0-1.0) derived by TTO technique (lifetime traded against perfect vision) and interval level Rasch scores of GAL-10 were used for analyses. Results Mean UV was 0.81 (95% confidence interval [CI], 0.78-0.84); that is, a decrease in quality of life (QoL) of 19%. Of the subjects, 59% were willing to trade lifetime in return of perfect vision; those willing to trade were significantly younger with poorer acuity in the worse-seeing eye. In univariate and multivariate analysis, severe VF loss in the worse eye was associated with lower UV (β = -0.108; 95% CI, -0.201 to -0.014; P = 0.02). Conclusions Our results show that primary glaucoma in adults causes substantial decrease in UVs (and QoL thereof), and is highly dependent on the severity of VF loss in the worse eye.

A healthy 3-month-old boy was brought to the emergency department with acute onset of corneal edema of the left eye. One hour before presentation, his parents noticed that the left cornea was cloudy and the right eye was normal after he had been crying.

A unique form of anterior segment hemorrhage called Pre-Descemet's hematoma is a previously unreported type of hemorrhage in which blood collects in the narrow space between the corneal stroma and detached Descemets membrane, which in our case was because of congenital glaucoma associated with Haab's straie. [Ophthalmic Surg Lasers 2000;31:427-428]

AIM—To evaluate the efficacy of intravitreal dexamethasone co-administered with intravitreal antibiotics along with vitrectomy in the management of exogenous bacterial endophthalmitis. METHODS—In a prospective randomised clinical trial, 63 patients (63 eyes) with suspected bacterial endophthalmitis (postoperative and post-traumatic) were treated with vitrectomy and intravitreal antibiotics and randomised to intravitreal dexamethasone (IOAB with = 29 eyes) and no dexamethasone (IOAB without = 34 eyes). Inflammation score (IS) and visual acuity were measured by two masked observers before surgery, and at 1, 4, and 12 weeks after surgery in both the groups. RESULTS—There was significant reduction (p