Gamification Design on Invisible Display for Amblyopia Treatment in Indian Children: Preliminary Design Intervention Study (Preprint)

2021 ◽  
Author(s):  
Yo Ishigaki ◽  
Kalpit Shah ◽  
Vaishali Prajapati ◽  
Tomoya Handa ◽  
Shinji Yokogawa ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Home Health Care ◽  
Low Income ◽  
Game Design ◽  
Indian Children ◽  
Number Of Patients ◽  
Improvement Effect ◽  
Therapy Room ◽  
Vision Therapy ◽  
Parameter Estimators

BACKGROUND India has the highest number of patients with amblyopia worldwide. For this study, we have developed a novel gaming tablet for amblyopia treatment, called Occlu-tab, which can present visual stimuli to only one eye while both eyes are open. OBJECTIVE To investigate if Occlu-tab, a gaming tablet with invisible display, is effective in improving visual acuity in children with amblyopia. METHODS We recruited 12 children with amblyopia in India to undergo Occlu-tab training. With Occlu-tab, we used eight games to provide patients with well-known techniques for vision therapy: fixation, eye-hand coordination, and pursuit eye movement. Participants were instructed to play with the Occlu-tab in a silent therapy room for 60 min per day, 3 days per week, for 6 weeks while wearing perfectly corrected glasses. The best-corrected visual acuity was determined every 2 weeks until the end of the treatment. RESULTS All 12 participants showed improved visual acuity after 4-6 weeks of treatment. The treatment games were well received by Indian children, and several requests for additional types of games were made. Parameter estimators for fixed effect showed high significance (P<.001), which suggests an evident improvement effect of the Occlu-tabs. CONCLUSIONS Occlu-tab was effective in improving visual acuity in children with amblyopia. However, game design should be improved based on the analysis of cultural and religious practices. Several patients refused to participate in the trial since they were unable to report to the hospital regularly due to financial reasons. This observation demonstrates the need for home treatment for low-income patients. In addition, home health care will be very important under a pandemic or lockdown caused by coronavirus disease 2019. In the future, this technology will be required in more accessible devices, such as televisions, smartphones, and tablets.

Successful Combination Therapy for Amblyopia Secondary to Micro-Esotropia And Anisometropia

2021 ◽  
pp. 195-200
Keyword(s):  
Visual Acuity ◽  
Combination Therapy ◽  
Refractive Error ◽  
Combination Treatment ◽  
Current Treatment ◽  
Short Term ◽  
Eccentric Fixation ◽  
Case Summary ◽  
Vision Therapy ◽  
Spectacle Correction

Background: Micro-esotropia is a small-angle esodeviation typically less than nine prism diopters. Patients with this ocular condition often develop amblyopia due to the presence of a constant unilateral strabismus and an anisometropic refractive error in the deviated eye. Current treatment methods for strabismic and refractive amblyopia include spectacle correction, patching, and vision therapy (VT). Case Summary: A 9-year-old Asian female presented with a constant left primary micro-esotropia with unsteady eccentric fixation, contributing to mild amblyopia and frequent suppression in the left eye. She also had a hyperopic anisometropic refractive error. Combination treatment of in-office VT with short-term patching therapy (two hours per day) was administered, with the goal of improving her binocularity, fixation, and visual acuity. Conclusions: Amblyopia results from binocular dysfunction, therefore monocular patching therapy alone will not improve the underlying issue. VT is necessary to actively treat binocularity and subsequently improve visual acuity, while short-term patching can be used in combination to effectively target monocular accommodation and fixation.

scholarly journals Quantifying the under-estimation of cervical Cancer in remote regions of Tanzania

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mariah P. Gesink ◽  
Robert M. Chamberlain ◽  
Julius Mwaiselage ◽  
Crispin Kahesa ◽  
Kahima Jackson ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Low Income ◽  
Population Based ◽  
Capital City ◽  
Low Income Countries ◽  
Treatment Center ◽  
Large Country ◽  
Number Of Patients ◽  
Sub Saharan ◽  
Radiotherapy Treatment

Abstract Background Cervical cancer is the most common cancer among women in Sub-Saharan countries, including Tanzania. While early detection and diagnosis are available in some parts of this large country, radiotherapy has been only available at the Ocean Road Cancer Institute (ORCI), in the capital city of Dar es Salaam and is just starting in a few regions. Methods The objective of this study was to compare the observed incidence of cervical cancer for the two remote regions of Mwanza in western Tanzania and Mbeya in southern Tanzania, based on their patients treated at the ORCI from 2011 to 2014. Results: The number patients referred and treated at ORCI were (120 from Mwanza, and 171 from Mbeya, representing 24.6 and 32.8% of the patients histopathologically confirmed in the two sites, respectively. The results showed significant underestimation of cervical cancer in the two regions. The vast majority of patients who were histopathologically-confirmed in their local regions (73.92% from Mwanza and 65.1% from Mbeya), but did not receive the needed radiotherapy treatment at the ORCI. The estimated incidence for the two regions based on the number of patients treated at the ORCI were underestimated by 53.9% for Mwanza and 68.9% for Mbeya. Conclusions Local establishment of radiotherapy treatment facilities in remote regions in Tanzania and similar other low-income countries is essential for providing effective treatment and improving survival of diagnosed cervical cancer patients. Linkage between the records of local remote hospitals and the main cancer treatment center in the capital city can also help support the emerging the population-based cancer registry at ORCI.

scholarly journals Gambaran Kualitas Hidup pada Pasien Diabetik Retinopati Berdasarkan Tingkat Keparahan Visus

2020 ◽  
Vol 10 (2) ◽  
pp. 105
Author(s):  
Novita Dhewi Ikakusumawati ◽  
Dewi Magistasari ◽  
Novena Adi Yuhara ◽  
Tri Murti Andayani ◽  
Supanji Supanji ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Utility Score ◽  
Microvascular Complications ◽  
Cross Sectional ◽  
Number Of Patients ◽  
High Prevalence ◽  
Anxiety Depression

Diabetic retinopathy (DR) is one of the microvascular complications of diabetes mellitus (DM) which incidence increases with the high prevalence of DM. The presence of these complications will affect quality of life, especially vision-related. The purpose of this study was to determine the quality of life in RD patients assessed using the VFQ-25 and EQ-5D questionnaires, and to determine the of quality of life based on the visual acuity (VA) severity. This study was an observational study in outpatient with diabetic retinopathy during October 2018 – Januari 2019 period, in RSUP dr. Sardjito and RS Mata Dr. YAP, Yogyakarta. The design of this study was cross sectional which observed quality of life and vision. Quality of life was measured by specific for vision instrument (NEI-VFQ-25)  and  generic instrument  (EQ-5D-5L). The number of patients in this study were 100 patients with an average age of 55 years, the most frequent type of RD was 84% proliferative RD. The average quality of life scores in RD patients measured using the VFQ-25 and EQ-5D utility questionnaires were 64.1 ± 16.2 and 0.61 ± 0.24, respectively. Based on VFQ-25, the most affected subscales were driving, dependence, and role difficulties subscale. Meanwhile, domains that have the most problems with the EQ-5D were pain / discomfort and anxiety / depression (78%). The total VFQ-25 score decreased with increasing visual severity, i.e. normal / mild (n = 19) 73.50 ± 15.08; moderate (n = 15) 68.14 ± 15.33; and severe (n = 66) 60.48 ± 15.64. The EQ-5D utility score showed a similar pattern, with scores of 0.66 ± 0.27 (normal / mild); 0.65 ± 0.22 (medium); and 0.59 ± 0.24 (severe); respectively. The higher severity of visual acuity so the quality of life become lower.

scholarly journals Vitrectomy for branch retinal vein occlusion with vitreous hemorrhage: proposal for a new grading system

2020 ◽  
Author(s):  
Gengmin Tong ◽  
Xuting Hu ◽  
Chenlei Zhu ◽  
Zhiqiang Gao ◽  
Xuhao Chen ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Vitreous Hemorrhage ◽  
Grading System ◽  
Vein Occlusion ◽  
Number Of Patients ◽  
Surgical Methods ◽  
Significant Difference ◽  
Grade Iii

Abstract Purpose To investigate the long-term surgical outcomes after treatment with pars plana vitrectomy (PPV) combined with photocoagulation in different severities of branch retinal vein occlusion (BRVO) with vitreous hemorrhage (VH) in order to propose a new grading system. Methods We retrospectively reviewed the medical records of 117 eyes of 117 patients who underwent PPV for VH associated with BRVO and who were followed up for at least 12 months. Preoperative best-corrected visual acuity (BCVA), surgical intervention, final BCVA, and central foveal thickness (CFT) were evaluated using optical coherence tomography. We proposed a system to grade BRVO with VH from Grade I to Grade III with increasing severity: Grade I,pure persistent VH; Grade II,VH with epiretinal membrane (EM) (Grade IIa,VH with EM without macular involvement; Grade IIb,VH with EM with macular involvement); and Grade III,VH with tractive retinal detachment. Different surgical methods were appliedaccording to the different retinal conditions. Results BCVA significantly improved at final follow-up in all groups. There was no significant difference among the four groups in terms of preoperative BCVA, final BCVA,CFT,or the number of patients whose macular edema recurred after surgery (p>0.05), but there was a significant difference in vision improvement(p<0.05). Vision improvement in the Grade IIb group was significantly worse than in the Grade I group(p=0.006) and in the Grade IIa group(p=0.046). The percentage of patients in the Grade I, Grade IIa, Grade IIb, and Grade III groups needing further laser treatment after surgery was 0%, 8.3%, 16.3%, and 23.5%, respectively (p<0.05). Conclusion We proposed a new grading system for BRVO treated with PPV. Vitrectomy is a safe and effective treatment for BRVO with VH. Visual acuity improvement was significantly worse when the EM had macular involvement (Grade IIb).

Impact of Medicaid expansion on pancreatic cancer care: A difference-in-difference analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18567-e18567
Author(s):  
Ahmad Hamad ◽  
Mariam Eskander ◽  
Yaming Li ◽  
Oindrila Bhattacharyya ◽  
James L Fisher ◽  
...  
Keyword(s):  
Low Income ◽  
Early Stage ◽  
Ductal Adenocarcinoma ◽  
Control Group ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Post Surgery ◽  
Number Of Patients ◽  
The Impact ◽  
Expansion Period

e18567 Background: The Affordable Care Act (ACA) increased insurance coverage for low-income individuals, which should potentially lead to better access to care and improved oncological outcomes. This study seeks to evaluate the impact of Medicaid expansion (ME) on care for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who were uninsured or on Medicaid and diagnosed with PDAC between 2004 and 2017 were queried from the National Cancer Database (NCDB). Two different expansion cohorts were included: early expansion states and 2014 expansion states. For early expansion states, the time period of pre-expansion was 2004-2009 and post-expansion was 2010-2017. As for the 2014 expansion states, the pre-expansion period was from 2004-2013 and post-expansion period was from 2014-2017. Patients in non-expansion states formed the control group. A difference-in-difference (DID) analysis was used to assess the association of ME with stage of diagnosis, treatment and survival for each expansion cohort. Results: In both early and January 2014 expansion states, there was an increase in overall Medicaid coverage (Early: DID = 0.29, 2014: DID = 0.37; P < 0.001), in particular for non-Hispanic Black and Hispanic Black patients (Non-Hispanic Black: Early: DID = 0.11, 2014: DID = 0.11; P < 0.001, Hispanic-Black: 2014: DID = 0.20; P = 0.003). There were no differences in early stage diagnosis (Early: DID = 0.02, 2014: DID = -0.02; P > 0.05). There was an increase in the number of patients receiving surgery (Early: DID = 0.05; P = 0.001, 2014: DID = 0.03; P = 0.029) but no difference in time to surgery among patients receiving surgery upfront (Early: DID = 1.75, 2014: DID = 0.38; P > 0.05). There was no difference in 30-day readmission post-surgery (Early: DID = 0.003; 2014: DID = -0.00007; P > 0.05) or 90-day mortality (Early: DID = -0.007, 2014: DID = -0.035; P > 0.05). Moreover, there was no difference in receipt of chemotherapy (Early: DID = 0.01, 2014: DID = 0.005; P > 0.05) or time to chemotherapy for patients receiving neoadjuvant chemotherapy (Early: Early: DID = 9.62, 2014: DID = 0.01; P > 0.05). Finally, there was no difference in receipt of palliative care among stage IV patients in both cohorts (Early: DID = -0.004, 2014: DID = 0.004; P > 0.05). Conclusions: This study suggests that after ME, PDAC patients were more likely to be insured and had increased access to surgical care. Future, studies should evaluate the implications of improved surgical access on clinical outcomes such as mortality.

scholarly journals Presentation, surgery and 1-year outcomes of childhood cataract surgery in Tanzania

2020 ◽  
pp. bjophthalmol-2020-316042
Author(s):  
Furahini Godfrey Mndeme ◽  
Blandina Theophyl Mmbaga ◽  
Mchikirwa Msina ◽  
Judith Mwende ◽  
Sonia J Vaitha ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Low Income ◽  
Visual Outcome ◽  
Low Income Countries ◽  
Similar Proportion ◽  
Poor Visual Outcome ◽  
A Prospective Study ◽  
Good Vision ◽  
Childhood Cataract

BackgroundRecent reports have suggested a significant change in the causes of blindness in children in low-income countries cataract becoming the leading cause. We aimed to investigate the presentations and surgical outcomes in children with cataract operated at different ages in Tanzania.MethodsWe conducted a prospective study of 228 children aged ≤192 months at three tertiary centres, 177 with bilateral cataracts and prospectively followed them for 1-year postsurgery. We collected demographic, surgical, preoperative and postoperative clinical characteristics using the standard childhood cataract surgical assessment questionnaire. Families were encouraged to return for follow-up by phone with travel reimbursement where necessary.ResultsPreoperatively, 76% bilateral children were blind in the better eye. 86% of children were followed up at 1 year and 54% bilateral children achieved visual acuity of 0.48 logMAR or better in the better eye and 5% were blind. 33% of unilateral children achieved visual acuity of 0.48 logMAR or better and 17% were blind. Preoperative blindness (adjusted OR (AOR) 14.65; 95% CI 2.21 to 97.20), preoperative nystagmus/strabismus (AOR 9.22; 95% CI 2.66 to 31.97) and aphakia (AOR, 5.32; 95% CI 1.05 to 26.97) predicted poor visual outcome in bilateral cases. 9% of 342 refracted eyes had initial postoperative cylinder of 1.5 D or more, as did a similar proportion (11%) of 315 eyes refracted 1 year after surgery. Acute fibrinous uveitis occurred in 41 (12%) eyes.ConclusionThree-quarters of children were blind preoperatively whereas over half had good vision 1-year postoperatively. Preoperative blindness, nystagmus/strabismus and aphakia predicted poor visual outcome, suggesting that cataract density determines density of amblyopia.

scholarly journals Aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies in immune-mediated optic neuritis at long-term follow-up

2019 ◽  
Vol 90 (9) ◽  
pp. 1021-1026 ◽  
Author(s):  
Axel Petzold ◽  
Mark Woodhall ◽  
Z Khaleeli ◽  
W Oliver Tobin ◽  
Sean J Pittock ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Serum Levels ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Aquaporin 4 ◽  
Oligoclonal Bands ◽  
Antibody Testing ◽  
Serum Samples ◽  
Original Cohort ◽  
Number Of Patients ◽  
The Impact

ObjectivesTo re-evaluate serum samples from our 2007 cohort of patients with single-episode isolated ON (SION), recurrent isolated ON (RION), chronic relapsing inflammatory optic neuropathy (CRION), multiple sclerosis-associated ON (MSON) and neuromyelitis optica (NMO).MethodsWe re-screened 103/114 patients with available serum on live cell-based assays (CBA) for aquaporin-4 (AQP4)-M23-IgG and myelin-oligodendrocyte glycoprotein (MOG)-α1-IgG. Further testing included oligoclonal bands, serum levels of glial fibrillar acidic and neurofilament proteins and S100B. We show the impact of updated serology on these patients.ResultsReanalysis of our original cohort revealed that AQP4-IgG seropositivity increased from 56% to 75% for NMO, 5% to 22% for CRION, 6% to 7% for RION, 0% to 7% for MSON and 5% to 6% for SION. MOG-IgG1 was identified in 25% of RION, 25% of CRION, 10% of SION, 0% of MSON and 0% of NMO. As a result, patients have been reclassified incorporating their autoantibody status. Presenting visual acuity was significantly worse in patients who were AQP4-IgG seropositive (p=0.034), but there was no relationship between antibody seropositivity and either ON relapse rate or visual acuity outcome.ConclusionsThe number of patients with seronegative CRION and RION has decreased due to improved detection of autoantibodies over the past decade. It remains essential that the clinical phenotype guides both antibody testing and clinical management. Careful monitoring of the disease course is key when considering whether to treat with prophylactic immune suppression.

Are Flash-evoked Visual Potentials Useful for Intraoperative Monitoring of Visual Pathway Function?

Neurosurgery ◽  
1987 ◽  
Vol 21 (5) ◽  
pp. 709-715 ◽  
Author(s):  
Cornelia Cedzich ◽  
Johannes Schramm ◽  
Rudolf Fahlbusch
Keyword(s):  
Visual Acuity ◽  
Visual Function ◽  
Intraoperative Monitoring ◽  
Light Emitting Diode ◽  
Visual Pathway ◽  
Light Emitting ◽  
Reversible Potential ◽  
Number Of Patients ◽  
Pathway Function ◽  
Potential Loss

Abstract Flash-evoked visual potentials (VEPs) recorded from the scalp were used in a series of 35 patients with tumors along the visual pathway: 3 orbital tumors, 25 perisellar tumors, 4 intraventricular tumors, and 3 occipital lesions. Preoperatively, various combinations of impaired visual fields and visual acuity were observed in over 90% of the patients. A postoperative decrease in visual function was observed in 3 cases. Of the 25 perisellar lesions, 13 were operated through a standard frontotemporal craniotomy and 12 were operated through a transnasal-transsphenoidal approach. VEPs were highly susceptible to volatile anesthetics, and there was a significant incidence of spontaneous latency increases and amplitude decreases in a large number of patients. There was an unacceptably high number of cases with significant VEP alteration occurring without concomitant visual function change. During trepanation or the transnasal approach, a reversible potential loss was observed in 11 patients, a profoundly altered wave form was seen in 8 cases, and a loss of single peaks was observed in 15 patients. During dissection of the tumor, a reversible potential loss or a potential with unidentifiable peaks was found in 25 cases; however, the VEPs recovered during closure or in the recovery room. There was no correlation between intraoperative VEP changes and the postoperative changes in visual function. In only 1 patient with an insignificant postoperative decrease in visual acuity from 0.4 to 0.3 was there a concomitant intraoperative potential loss. The major conclusion of our findings is that light-emitting diode flash-evoked VEPs demonstrate intraoperative changes that appear too early and too prominently to be caused solely by manipulation of the optic pathways. Therefore, light-emitting diode flash-evoked potentials do not seem to be a suitable instrument for the intraoperative monitoring of visual pathway function. (Neurosurgery 21:709-715, 1987)

scholarly journals Community-Based Hearing and Vision Screening in Schools in Low-Income Communities Using Mobile Health Technologies

2021 ◽  
pp. 1-13
Author(s):  
Michelle Manus ◽  
Jeannie van der Linde ◽  
Hannah Kuper ◽  
Renate Olinger ◽  
De Wet Swanepoel
Keyword(s):  
South Africa ◽  
Visual Acuity ◽  
Mobile Health ◽  
Low Income ◽  
Vision Loss ◽  
Health Workers ◽  
Screening Program ◽  
Hearing Screening ◽  
Vision Screening ◽  
Health Technologies

Introduction Globally, more than 50 million children have hearing or vision loss. Most of these sensory losses are identified late due to a lack of systematic screening, making treatment and rehabilitation less effective. Mobile health (mHealth), which is the use of smartphones or wireless devices in health care, can improve access to screening services. mHealth technologies allow lay health workers (LHWs) to provide hearing and vision screening in communities. Purpose The aim of the study was to evaluate a hearing and vision school screening program facilitated by LHWs using smartphone applications in a low-income community in South Africa. Method Three LHWs were trained to provide dual sensory screening using smartphone-based applications. The hearScreen app with calibrated headphones was used to conduct screening audiometry, and the Peek Acuity app was used for visual acuity screening. Schools were selected from low-income communities (Gauteng, South Africa), and children aged between 4 and 9 years received hearing and vision screening. Screening outcomes, associated variables, and program costs were evaluated. Results A total of 4,888 and 4,933 participants received hearing and vision screening, respectively. Overall, 1.6% of participants failed the hearing screening, and 3.6% failed visual acuity screening. Logistic regression showed that female participants were more likely to pass hearing screening ( OR = 1.61, 95% CI [1.11, 2.54]), while older children were less likely to pass visual acuity screening ( OR = 0.87, 95% CI [0.79, 0.96]). A third (32.5%) of referred cases followed up for air-conduction threshold audiometry, and one in four (25.1%) followed up for diagnostic vision testing. A high proportion of these cases were confirmed to have hearing (73.1%, 19/26) or vision loss (57.8%, 26/45). Conclusions mHealth technologies can enable LHWs to identify school-age children with hearing and/or vision loss in low-income communities. This approach allows for low-cost, scalable models for early detection of sensory losses that can affect academic performance.

scholarly journals Outcomes of Dialysis in low Income Country – An Experience in a Tertiary Care Center of Bangladesh

2021 ◽  
Vol 33 (1) ◽  
pp. 52-56
Author(s):  
Ratan Das Gupta ◽  
Syed Mahbub Morshed ◽  
Abdullah Al Mamun ◽  
HAM Nazmul Ahsan ◽  
Mirzul Hasan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Disease ◽  
Low Income ◽  
End Stage Renal Disease ◽  
Case Record ◽  
Average Life Span ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: The widespread use of hemodialysis to prolong life of end-stage renal disease (ESRD) patients has been a remarkable achievement, preventing death from uremia in these patients. The aim of the study was to find out the outcomes of haemodialysis patients with end-stage renal disease (ESRD) in low Income County. Methods: A hospital based prospective observational study was performed in the of Department of Nephrology, Shaheed Suhrawardy Medical College. Total 189 patients who stated dialysis during study period were included. All patients were monthly followed up and appropriate investigation done. All data recorded in a case record form. Study protocol approved by Ethical committeeof institute. Data analyzed in SPSS software version 25. Results: Among 189 ESRD patients on MHD selected with mean age 49.16 years (15-82), male was 60.3% and female 39.7%.Eighty eight 46.5% patient died and 39.15%(74) patient discontinue dialysis due to lack of financial support or helping assistant or social support. Three (1.6%) patients underwent renal transplantation and five patients (2.6%) transfer to other dialysis center. Average life span in dialysis 256 day (16-786 days). Most of the paints was on twice weekly dialysis 84%. Vascular access of stating dialysis was 73.8% by catheter and only 32.2% stated with AV fistula. Conclusion: A large group of patients leave dialysis due to financial or helping personal or social supportwithin 3-4 months of stating dialysis. A significant number of patients died due to multiple risk factors within 8-9 months. Identification of risk factors for early mortalityis essential and appropriatemeasure should take to prevent discontinuation at community and national level. Bangladesh J Medicine July 2022; 33(1) : 52-56

Sign in / Sign up

Export Citation Format

Share Document