Purpose: To document the prevalence of vision impairment among children in a resource-poor community in Peru. Methods: Cross-sectional study of children 5 to 18 years old in Puente Piedra, Peru from March to April, 2011. Participants underwent standard vision screening exam, consisting of distance visual acuity (VA), stereopsis, external eye exam, and color vision testing and completed a socio-demographic and health risk factor questionnaire. Results: 380 children were examined. The mean uncorrected VA was 0.07 ± 0.13 Log Mar. Children wearing eyeglasses were 3.7%. Visual impairment was found in both eyes in 8.9% and in one eye in 26.3%. Severe visual impairment (<20/200) was found in both eyes in one child (0.3%) and in the worse eye of 3 (0.7%) children. Thirteen (3.5%) children failed the stereopsis exam and 20 (5.5%) boys and 7 (1.9%) girls failed the color vision exam. Overall, 37.3% of children met the criteria for referral to an ophthalmologist. Major factors for referral included the history of eyeglasses use, previous eye exam, or parental concern about the child's vision. Factors for untreated vision impairment included not having seen a physician regularly, no previous eye exam, and having a blind family member. Conclusion: There is a high prevalence of vision impairment in children living in Puente Piedra, Peru. Few children wore glasses or have ever been examined before. Basic eye care is needed for this underprivileged population.

Purpose: Determine if anterior stromal puncture (ASP) has a more effective decrease in symptomatology (pain, photophobia, and foreign body sensation) than annular keratotomy (AK) in patients with painful bullous keratopathy (PBK) and poor visual prognosis. Methods: Patients with PBK, refractory to combined medical treatment and poor visual prognosis were randomly assigned to one of two surgical procedures. Symptomatology, central corneal thickness (CCT), visual acuity (VA), and best corrected (BCVA) were evaluated with a 12-month follow up. Results: From 78 patients with PBK, 13 met inclusion criteria; ASP was performed to 7 and AK to 6 of them. There was improvement in the magnitude of symptoms in both groups; however, there was no difference when groups were compared. CCT showed in the 7-month follow-up a significant reduction of 10.4% in the ASP group compared with a 9.6% increase in the AQ group (p=0.05). Twelve-month-follow up CCT presented a non-significant reduction of 9.3% in the ASP group compared with a 3.3% increase in the AQ group. VA and BCVA in both groups were not modified. None of the groups presented complications related to the surgical procedures. Conclusion: In this clinical trial, we documented that ASP and AQ produce a similar improvement in the symptomatology of patients with PBK refractory to combined medical treatment and poor VA potential. The ASP group additionally presented a significant decrease in CCT at 7 months of follow up, which looses statistical significance at 12 months of follow up, but maintains a clinical reduction of 9.3%. A longer follow-up period would be required to evaluate if this CCT reduction is able to modify the frequency of bullae development and symptoms relapse. Furthermore, the material used for ASP has a lower cost than the one used for AQ, which could represent an economic advantage for patients that attend our Hospital.

Purpose: To compare the prevalence of angle closure disease (ACD) diagnoses in a glaucoma department of an ophthalmology teaching hospital at two cut points, before and after encouragement of a supervised, mandatory gonioscopy for all patients, during all visits as well as to profile patients with angle closure disease in terms of age, gender, intraocular pressure, visual acuity, cup-to-disc ratio and refractive error parameters when divided by Foster's classification. Study design: Retrospective, two cut-point observational study. Material and methods: A 1-month sample of electronic medical records from 2010 and from 2013 was analyzed. Between those two cut points, gonioscopy was encouraged as a mandatory procedure and execution was supervised systematically. The prevalence of angle closure disease was obtained from the diagnosis of electronic medical records and patients with ACD were divided according to Foster's ACD classification in order to profile them. Results: A total of 2112 medical records from 2010 and 2549 medical records from 2013 were included. Angle closure disease prevalence went from 7.29% (n=154) in 2010 to 20.36% (n=519) in 2013. Prevalence of primary open angle glaucoma (POAG) decreased from 23.20% to 10.84% in the same time period. Conclusions: A comparison between the prevalence of angle closure disease between these two cut points showed a considerable increase. Angle closure disease was diagnosed 1.79 times more as opposed to when gonioscopy was not previously encouraged or supervised. ACD patients are generally women, with decreasing low hyperopia and intraocular pressure within normal ranges.

Purpose: Normal-tension glaucoma has been associated with systemic vascular diseases such as peripheral vasospasm. This study aims to evaluate the influence of peripheral vasospasm on the thickness of the retinal nerve fiber layer (RNFL) in Raynaud's disease (RD), and the correlation between global RNFL and peripheral microcirculation features in RD patients. Methods: Observational cross-sectional study of 18 patients (35 eyes) with a diagnosis of RD followed in our clinic, and 20 healthy controls (39 eyes). RNFL parameters were obtained using spectral domain optical coherence tomography (SD-OCT Spectralis®, Heidelberg). Global and sectorial peripapillary RNFL thickness were registered. Age, gender, refractive error, best-corrected visual acuity and intraocular pressure were determined, and slit-lamp biomicroscopy and fundus examination were performed. Nailfold videocapillaroscopy (NC) was performed in the RD group to characterize capillary morphology and blood flow. Mann-Whitney and Fisher's exact tests were used for statistical analysis. Statistical significance level was set at p<0.05 (two-sided). Results: There was no significant difference in the global RNFL between RD patients and the control group (p=0.35). The presence of avascular areas in NC was associated with a lower global RNFL thickness (p=0.026). Conclusion: The association between avascular areas in NC and the lower global RNFL thickness in RD patients suggests that systemic vasospasm severity may be related to optic nerve damage propensity. Therefore, its presence in NC may identify RD patients at risk for optic nerve head damage. A larger sample with a long-term study is needed to support the clinical and therapeutic implications of our findings.

Purpose: To compare biometrical measurements performed with the new IOLMaster-700 (Carl Zeiss Meditec AG, Jena, Germany) from those obtained with the Aladdin (Topcon, Tokyo, Japan). Methods: A prospective, cross-sectional, observational, comparative study was proposed. Twenty-four eyes were assessed using two biometry devices. Measurements of axial length (AL), anterior chamber depth (ACD), mean keratometry (KM), flattest (Kf) and steepest keratometry (Ks) and white-to-white (WTW) were done with both devices in a random order. Results: No statistically significant differences (p>0.05) between the two biometry were found for AL (24.22±0.92mm [range 22.66 to 26.09 mm] with IOL Master and 24.22±0.91mm [range 22.65 to 26.09 mm] with the Aladdin), ACD (3.59±0.26mm [range 3.05 to 4.11 mm] with IOL Master and 3.42±0.60mm [range 3.05 to 4.02 mm] with the Aladdin) and Kf (42.43±1.21 D [range 40.55 to 45.15 D] with IOL Master and 42.41±1.25 D [range 40.66 to 45.36 D] with the Aladdin). In Km (42.99±1.23 D [range 41.07 to 45.31 D] with IOL Master and 42.90±1.27 D [range 41.06 to 45.55 D] with the Aladdin), Ks (43.55±1.38 D [range 41.20 to 46.57 D] with IOL Master and 43.40±1.42 D [range 41.21 to 46.62 D] with the Aladdin) and WTW (12.32±0.40mm [range 11.6 to 13.1 mm] with IOL Master and 12.03±0.36 mm [range 11.46 to 12.87 mm] with the Aladdin), there was a statistical difference. Conclusions: Measurements with the new IOLMaster-700 correlated well with those obtained with the Aladdin in patients with clear lens; although a statistical difference was found in KM, Ks and WTW. This difference was not clinically significant.

Purpose: To determine choroidal thickness in preterm children with or without history of Retinopathy of Prematurity (ROP) with spectral domain optical coherence tomography (SD-OCT) system. Methods: In a cross-sectional study, 39 eyes of premature patients (Group 1) and 39 eyes of children with history of ROP (Group 2) between 9 and 17 years old were evaluated with Cirrus Zeiss 500 SD-OCT after cycloplegia. Choroidal thickness was measured from the fovea to 1500µm nasal and temporally with intervals of 500 µm using HD1 line raster program of SD-OCT. Clinical history of gestational age at birth, birth weight, time of oxygen exposure, stage of ROP in maximal severity of acute disease and ROP treatment were inquired. Results: Subfoveal thickness was lower in Group 2 (296,85±60,11µm) than in Group 1 (301,82±30,63µm). The mean choroidal thickness in all retinal tested points was not statistically different between groups. The time of oxygen exposure was the most relevant negative predictor considering choroidal thickness (β=-0,420; p= 0,032). Conclusions: Choroidal thickness can be measured using SD-OCT high definition raster scans in the majority of children. Comparing macular choroidal thickness in both groups, we found that it was thinner nasally, subfoveal and temporally in group 2, with no statistical significance. This can suggest a probable delayed choroidal development in preterm infant due to ROP, which can be attenuated with age.

Purpose: To evaluate the quality, readability and suitability of the information on glaucoma available in Portuguese in the Internet. Study design: Cross-sectional limited survey of internet resources. Methods: We used as keyword “GLAUCOMA” for research on four search engines in the internet. The first 30 sites that appeared on each search engine were recorded and those that appeared at least in two search engines were selected. The Sandvik score, Flesch-Kincaid formula and the Suitability Assessment of Materials (SAM) were used as tools to evaluate quality, readability and suitability, respectively. Results: The information provided on the websites presented moderate quality (mean Sandvik score 7.7 ± 1.4), readability of 16.0 ± 1.7 years of education and were unsuitable (mean SAM score 21.4 ± 6.4 %) for the target audience. Conclusion: Most websites about glaucoma had moderate quality. In order to understand the information, an average of 16 years of formal education was deemed necessary. All websites were unsuitable to the target population. RESUMO Objetivos: Avaliar a qualidade, a apreensibilidade e adequabilidade das informações sobre o glaucoma, em português, disponibilizadas na internet. Desenho do estudo: Estudo transversal sobre sítios na internet. Métodos: Utilizou-se a palavra chave “GLAUCOMA” em quatro buscadores para a pesquisa na internet. Os 30 primeiros sites que apareceram em cada buscador foram registrados e aqueles que apareceram em pelo menos dois buscadores foram incluídos no estudo. Como ferramentas para a avaliação da qualidade, apreensibilidade e adequabilidade foram utilizados o escore de Sandvik, o índice de Flesch-Kincaid e o Suitability Assessment of Materials (SAM), respectivamente. Resultados: A informação disponibilizada nos sites selecionados apresentou qualidade mediana (escore médio de Sandvik 7,7 ± 1,4), apreensibilidade média de 16,0 ± 1,7 anos de escolaridade e foi considerada inadequada para o público-alvo (SAM médio de 21,4 ± 6,4 %). Conclusão: A maioria dos sites na internet sobre glaucoma apresentou qualidade moderada. Para a leitura compreensível da matéria contida nos sites, era necessário que o leitor tivesse pelo menos concluído a terceira série do ensino médio. Todos os sites foram considerados inadequados para a compreensão da informação publicada. Palavras-chave: Glaucoma; informação; internet; Controle de Qualidade; Educação de Pacientes.

Purpose: To determine the incidence of intraretinal hemorrhage in newborns at the Hospital de San José, Bogotá, Colombia from September 2009 to September 2010. Design: Cohort study. Methodology: Live newborns were examined at the San José Hospital for a year (September 2009 to 2010), analyzing neonatal and maternal factors associated with the presence of intraretinal hemorrhages. A simple random cluster sampling was used, excluding newborns with a compromised general status, as well as those whose parents or legal guardians did not sign the informed consent form. Patients with the presence of intraretinal hemorrhages were examined every 2 weeks until resolution was observed. Results: A total of 190 newborns were examined, finding an incidence of intraretinal hemorrhages of 22.6% (95% CI 16.6 to 28.6). Most of the mothers were nulliparous (55.8%) and deliveries were eutocic (65.1%). From newborns with hemorrhages, 81.3% were born at term, and hemorrhages in most patients (93.0%) were resolved by the second week of monitoring. Associations between hemorrhages and cesarean section (RR 0.42, CI 0.22 to 0.79) and episiotomy (RR 1.73, CI 1.02 to 2.94) were observed. Conclusions: Newborns who presented intraretinal hemorrhages were children of nulliparous mothers on whom episiotomy was performed, and some with eutocic and instrumented deliveries. The first two variables had statistical significance for the development of intraretinal hemorrhages.

Prupose: To confirm the microbiological presence of C. trachomatis in indigenous communities of Colombia found to have cases of active trachoma. Method: An ophthalmic evaluation was performed in order to identify the active forms of the disease. Ocular swabs were taken from the conjunctiva and analyzed by real-time PCR “in house” for the detection of C. trachomatis. Positive samples were confirmed with a commercial real time PCR and DNA sequencing. Study Design: Descriptive study. Subjects: Children with active trachoma from different indigenous communities in Vaupés, Colombia. Main outcome measures: Presence of C. trachomatis in conjunctival swab samples. Results: Fifteen clinical cases of active trachoma were identified in children between one and 12 years old. A major proportion of TI was observed, compared with TF and greater bilateral commitment of the disease. Patients were from the indigenous communities of Santa Catalina (73.3%), Pacuativa (20%) and Piramirí (6.7%). The presence of C. trachomatis was confirmed in 3 (20%) patients, by real time PCR technique “in house” and confirmatory, and validated with sequencing. Conclusion: This study confirms the presence of C. trachomatis in cases of active trachoma in indigenous communities of the department of Vaupés, Colombia.

Purpose: To analyze eye health and visual acuity in children and teenagers to promote early detection and treatment of visual impairments. Methods: Public school students were pre-screened by teachers, and those who presented behavior, signs, or symptoms of decreased visual acuity (VA) or any other type of ophthalmological disorder, participated in a VA screening. The VA was registered for each eye, with or without optical correction. Children with VA less than or equal to 0.18 (logMAR) in the worst eye, and/or with complaints of asthenopia, eye irritation and itching, strabismus, conjunctival or corneal lesions were referred to the Ophthalmology Department of Celso Pierro Hospital for a complete ophthalmological evaluation. Results: Fifty (52.63%) patients were male and 45 (47.37%) were female. The average age of the participants was 10 years. Their eyes were evaluated and 114 (77.03%) presented refractive errors; 7 (9.45%) of the patients who were referred to the clinic already wore prescription eyeglasses, and all of them had inappropriate refractive correction. Conclusion: The most common refractive errors were: astigmatism in 94 (82.45%) children, myopia in 14 (9.72%) and hyperopia in 6 (4.16%). The conclusion is that there are not enough visual campaign and screening exams in public schools.

Purpose: To correlate macular pigment density in patients without ocular pathology and risk factors for development of DMLI. Study design: Transversal study. Methods: 119 eyes from 60 patients (34 women and 26 men) without ocular pathology and with risk factors for DMLI seen at Garcia de Orta Hospital between June and August 2013. Macular pigment density was evaluated with heterochromatic flicker photometry (QuantifEYE®). All participants received a complete ophthalmological examination and respond a questionary about their actual health status, lifestyle and demographic information. Results: The macular pigment density average was 0,4450 ± 0,09932. We noticed a negative and statistical significant correlation between macular pigment density and the following risk factors: age, HbA1c in diabetics, hypercholesterolemia, systolic arterial pressure, tobacco exposure and ex-smokers (p<0,05). It was observed a positive and statistical significant correlation between the ingestion frequency of food containing carotenoids and macular pigment density (p<0,05). Conclusions: Macular pigment density was lower according to age and risk factors for the development of ARMD Resumo Objetivo: Correlacionar a densidade de pigmento macular em indivíduos sem doença ocular com fatores de risco para a DMLI. Desenho do estudo: Estudo transversal. Métodos: 119 olhos de 60 pacientes (34 mulheres e 26 homens) sem doença ocular e com fatores de risco para DMLI identificados em primeira consulta no Serviço de Oftalmologia do Hospital Garcia de Orta entre Junho e Agosto de 2013. Avaliou-se a densidade de pigmento macular com fotometria heterocromática de Flicker (QuantifEYE®) de ambos os olhos. Realizou-se exame oftalmológico completo e foi elaborado um questionário sobre o estado de saúde, estilo de vida e demografia. Resultados: A média de densidade de pigmento macular foi de 0,4450±0,09932. Detetouse correlações negativas e estatisticamente significativas entre a densidade de pigmento e os seguintes fatores: idade, HbA1c dos diabéticos, colesterolémia, pressão arterial sistólica, unidade de maços de tabaco/ano nos fumadores e ex-fumadores (p<0,05). Existiu uma correlação positiva e significativa entre a frequência de ingestão de alimentos contendo carotenóides e a densidade de pigmento macular (p<0,05). Conclusões: Neste estudo, a densidade de pigmento macular apresentou tendência a diminuir com a idade e a ser inferior em indivíduos com fatores de risco para a DMLI.

Purpose: To trace the epidemiology of eye diseases seen in the emergency eye care center in Campinas, Brasil. Methods: A cross-sectional, observational, retrospective survey was conducted involving patient records assisted in the emergency room in January of 2014. The factors analyzed were age, gender, origin of patient and nosological entities. Results: A total of 1063 patients were attended. 55.9% were male and 44.1% female. Mean age was 37 years old. Of this sample, 18.2% were ocular trauma, 16.9% infectious conjunctivitis, 7.8% keratitis, 7.6% hordeolum, 7.5% ocular allergies, 4.7% subconjuntival hemorrhage, 3.9% blepharitis and meibomitis, 3.6% pterygium, 3.4% corneal ulcer and 26% other diagnosis. 73.5% were from emergency eye care admittance of our service and 26.5% were referrals from other services. Conclusion: The most frequent etiology was ocular trauma. The majority of patients were male in economically active age and their main origin was from admittance of emergency eye care center.

Introduction: Intraocular lens calculation has become one of the main features of cataract surgery. Accurate lens calculation is an important factor in patient satisfaction and quality of life. The purpose of our study is to evaluate which formula (SRK II, HofferQ, Holladay 1 and SRK-T) was nearest to the final refraction after cataract surgery, using the IOLMaster®. Material and Methods: We evaluated 101 eyes of 78 cataract patients. The expected refraction with the intraocular lens used in each patient was calculated with the different formulas and compared to the patient refraction one month after surgery. We obtained data retrospectively from 23 eyes with axial length inferior to 22 mm, 62 eyes with axial length between 22 and 26 mm and 16 eyes with axial length superior to 26 mm. Results: The mean refraction after cataract surgery for all patients was -0.277 diopters (D) ± 0.94. Hoffer Q performed better for eyes with axial length inferior to 22 mm with a mean absolute error (difference between lens calculation and final refraction) of 0.4957 D ± 0.396. For eyes with axial length between 22 and 26 mm SRK-T performed better with a mean absolute error of 0.4515 D ± 0.323 and for eyes with axial length superior to 26 mm SRK-T performed better with a mean absolute error of 0.5538 D ± 0.333. We did not find any statistical difference in the comparison between third generation formulas; we found statistical significance when comparing HofferQ and SRKII in the“inferior to 22 mm” group and SRK-T and SRKII in the“between 22 and 26 mm” group. Conclusions: All third generation formulas can be used to calculate the intraocular lens. We recommend using HofferQ in axial length inferior to 22 mm and using SRK-T in axial length superior to 22 mm.