Uncorrected or unaddressed refractive error (URE) is the leading cause of treatable visual impairment (VI) globally. A significant factor is the prohibitive costs of corrective options. The World Health Organization recently recommended the use of effective refractive error coverage (eREC) to determine the burden and management of URE. To increase eREC, spectacles should be made available and affordable. Most developing countries use ready-made glasses produced in bulk to address presbyopia. Timor-Leste employed a tiered- pricing for these ready-made spectacles which were found to be effective. The Philippines can adopt similar initiatives considering that prescription spectacles are not covered by its national health insurance. Prescription spectacles should also receive coverage from the national insurance. Policies should also be created that will set-up optical units inside government hospitals and primary health care units that can dispense low cost or free prescription spectacles. Dedicated government posts for optometrists should be created to man the said units. Existing colleges of optometry can partner with nearby public health facilities to man their optical units similar to partnerships made for other health professions. State universities can also consider opening colleges of optometry where they can tie up return services conditions or follow ladderized programs based on community demands similar to existing ones for other health professions
Refractive Error ; spectacles ; cost

Background: India has the highest incidence of retinoblastoma globally and is one of the six Asian countries identified to contribute 43% to the global retinoblastoma cases. Data on clinical presentation, treatment, and outcomes were reviewed which can serve as basis in the creation of clinical guidelines, policies and programs, and resource allocation in the diagnosis and management of retinoblastoma in India. Methodology: Articles on retinoblastoma in India gathered from different databases were reviewed for clinical features, treatment, and outcomes. Result: Fourteen articles with 3,666 patients involving around 4,945 eyes seen from 1983-2017 were reviewed. The median age at consult ranged from 14-48 months. The median delay of consult ranged from 2-9 months. Majority of the patients were males (59%) and unilateral disease was present in 63%. Family history was reported in 4%. Retinoblastoma was intraocular in at least 75% of eyes. Systemic chemotherapy was the most used treatment option given to >2,042 eyes. Enucleation was done in >1,695 eyes. The mean follow-up period ranged from 4-50 months. Three hundred fifty six (356) patients were lost to follow-up. The functional vision was retained in 134 eyes. The globe salvage rate for Group A was 100%, 94-100% for Group B, and 50-100% in Group C. The highest globe salvage rate for Group D eyes was 85% and 58% for group E. The overall survival rate was 75% (2,233 patients). Conclusion Common among the articles was the relatively high proportion of extraocular disease attributed to delay in consult attributed to financial factors and lack of knowledge on the disease.
Retinoblastoma ; Therapeutics ; India ; Asia

Congenital cytomegalovirus (CMV) infection (cCMV) is challenging to differentiate from congenital rubella syndrome (CRS) clinically. Virus detection and serological tests are needed. However, they are often not readily available or are expensive. This is a case of a five-month-old male with bilateral cataracts. He was jaundiced at birth and started having seizure episodes at one month of age. He was also diagnosed with right inguinal hernia and had abnormal bilateral hearing tests. Both eyes were noted to have leukocoria at two months of age. There was dazzle on both eyes and sclerae were anicteric. Examination revealed dense cataracts on both eyes, but their ocular ultrasound results were essentially normal. Due to the bilateral hearing loss and bilateral cataracts, CRS was initially considered despite the absence of heart abnormality since there were reported CRS cases without the complete triad. However, possible coinfection or another disease was considered due to the presence of jaundice, seizures, and hernia, which were never seen in our previous CRS patients nor were reported in the literature. The patient underwent cataract extraction on both eyes without intraocular lens implantation (IOL) as recommended for CRS cataracts to prevent severe inflammation. TORCH (TOxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex) test was negative for rubella but positive for CMV. As such, the patient would have benefitted from early IOL implantation. The patient was then referred to a national medical center for possible treatment. However, since the patient already tested negative for CMV polymerase chain reaction (PCR) there, systemic antiviral therapy was no longer initiated. This case presented the challenge of clinically differentiating cCMV and CRS.
Cytomegalovirus Infections ; Rubella Syndrome, Congenital ; Hearing Loss ; Jaundice

Congenital rubella syndrome (CRS) cases being seen in a tertiary hospital in Baguio rose in 2020 during the COVID-19 pandemic. Its communicability presented logistical challenges to the hospital as additional contact and droplet precautions, including COVID-19 RT-PCR testing, were needed to be observed to prevent rubella transmission. The operations of the institute have also been disrupted and compromised since its space and resources were diverted to the pandemic response. A probable rubella transmission occurred when a patient with CRS was admitted for cataract surgery but was delayed due to the COVID-19 RT-PCR test requirement. Another patient admitted from the Outpatient Department on the same day developed maculopapular rashes for three days during admission but with no febrile episodes and lymphadenopathy. These cases showed how managing CRS cataracts got complicated by the current COVID-19 pandemic which resulted in the review and proposal to revise current hospital policies to minimize the exposure of vulnerable individuals and prevent future transmission.
Rubella Syndrome, Congenital ; Cataract ; COVID-19

Aicardi Syndrome (AS) is a rare X-linked congenital disorder traditionally characterized by a triad of dysgenesis of corpus callosum, seizures, and chorioretinal abnormalities. Patients often have severe psychomotor delay and shortened life expectancy. However, Aicardi syndrome is a clinically heterogeneous disorder. We present a case of a 14-year-old with the traditional triad of history of infantile spasm, complete agenesis of the corpus callosum, and chorioretinal abnormality but with peripapillary staphyloma and with no psychomotor delays. Based on the review of literature, this is the first reported case of AS in the Philippines, the first reported case of AS with peripapillary staphyloma, and is one of the 3 reported cases of AS with normal psychomotor development. There remains no factor that can prognosticate cognitive function in AS at present including genetic testing.

Background: Infants with congenital rubella syndrome (CRS) often require multiple diagnostic procedures and interventions that include cataract surgery and procedures for congenital heart abnormalities. CRS is a vaccine preventable disease. Objective: This study aimed to determine the costs incurred by the parents, Philippine Health Insurance Corporation (PHIC), hospital's medical social service (MSS), and non-governmental organization (NGO) in the management of CRS. Methods: This is a costing study of five children diagnosed with probable CRS who were managed in a tertiary government hospital in Northern Luzon, Philippines. The parents or guardians of the patients were interviewed on the cost incurred particularly on non-medical related expenses during their outpatient department consultations and admissions. Hospital bills from our institutions and those from the previous institutions, if available, were retrieved. Expenses incurred from procedures or medical supplies relating to known complications of CRS were included in the computation. Results: All five patients diagnosed with CRS had cardiac, ear, and eye manifestations. Two patients had postnatal complications. The average cost spent by the five patients' early years of life (mean age of patients was 16 ± 14 months) was ₱409,740.84. A quarter of the cost was out-of-pocket expenses while a third was covered by the hospital's MSS where the patients were seen. Another third was shouldered by an NGO. Most expenses were from the treatment of cardiac complications at 42% of the cost and had the highest average cost at ₱116,586.59. Case 1 had the highest financial cost at ₱833,514.24 mainly from the cardiac complications of CRS. Conclusion The cost of CRS in the early years of life is high. This is a significant financial burden to parents, PHIC, hospital's MSS, and NGO.
Congenital rubella syndrome ; cataract

Background: Optical coherence tomography (OCT) can accurately assess the optic nerve and retinal fiber layer (RNFL) to closely look at the anatomical ocular pathology of amblyopia. Objectives: This study aimed to determine and compare optic nerve parameters and RNFL in amblyopic and normal Filipino children using OCT. Methodology: Forty-two eyes of 21 normal participants and 40 eyes of 20 amblyopic participants underwent complete eye examinations and OCT scanning of optic nerve and RNFL. The following data were collected: age, refraction, intraocular pressure, optic nerve parameters (including rim area-vertical cross-section, average nerve width, disc diameter, cup diameter, rim length, vertical integrated rim area, horizontal integrated rim width, disc area, rim area, cup area, cup to disk area ratio, cup-to-disk horizontal ratio, cup to disc vertical ratio), and peripapillary RNFL. Results: There was a statistically significant difference between normal and amblyopic groups with regard to the following parameters: cup area, rim area, cup-disc area ratio, cup-disc horizontal ratio, cup-disc vertical ratio, superior RNFL, and inferior RNFL. The rim area was significantly smaller in amblyopic eyes compared to normal whereas the cup-disc area ratio, cup area, cup-disc vertical and horizontal ratios were significantly larger in amblyopic eyes. The RNFL inferiorly and superiorly were also thinner in amblyopic eyes. Conclusion As measured by OCT, some optic nerve parameters and RNFL thickness in Filipino children were significantly different in amblyopic eyes compared to normal.
Optic Nerve ; Amblyopia

Background and Objective: The Philippines does not have a national congenital rubella syndrome (CRS) surveillance or registry. Regular monitoring of CRS cases in hospitals, including in a Philippine tertiary hospital, helped in the past to provide clinico-epidemiologic data on CRS. This study aimed to continue providing clinico-epidemiologic data on CRS cases seen in the Philippine tertiary hospital from 2009-2012 and 2019-2022 and compare the cases seen from said timelines. Methods: A cross-sectional study was used, employing chart review of patients newly diagnosed with CRS from 2009-2012 and 2019-2022 in the Department of Ophthalmology and Visual Sciences at the Philippine tertiary hospital. Results: Forty-two patients newly diagnosed with CRS from 2009-2012 and 2019-2022 were included. Only 14 (33%) were serologically-confirmed cases (albeit qualitatively). Median age (first and third interquartile ranges) at consult was 1 year (0.4, 2.5). Twenty-four (57%) patients had maternal history of rashes and/or fever. Trimester of pregnancy when mother became symptomatic was not significantly correlated with chief complaint (p=0.20) and numbers of ophthalmic (p=0.68) and systemic manifestations (p=0.32). Cataract was the most common ophthalmic manifestation present in 40 (95%) patients. Twenty-six (62%) patients had other associated systemic findings of which hearing loss was the most common. Only 29 of 40 patients with cataract underwent lensectomy, with 23 patients having poor visual prognosis prior to surgery (5 with nystagmus alone, 10 with nystagmus and strabismus, and 8 with strabismus alone). Discussion: Using ophthalmic manifestations as primary indicator, this study provided an update on the CRS cases in the country. Laboratory confirmation remains a challenge in diagnosing CRS as the tests are costly and not widely available. There was increase from 2009-2012 compared to 2019-2022 in number of patients who underwent surgical treatment for cataract but visual outcomes were suboptimal due to delay in consultation. Although there was a decrease in number of CRS cases seen in the Philippine tertiary hospital, this cannot be attributed to increased rubella-containing vaccine (RCV) coverage alone. Conclusion Provision of data from individual hospital-based studies similar to this highlights the need for a national CRS surveillance system or registry. This can better gauge the burden of CRS and identify the gap in RCV coverage.
Rubella Syndrome, Congenital ; Retinitis Pigmentosa

Cranial nerve (CN) III palsy is rarely caused by intraorbital compression, let alone from a subgaleal abscess. We present a case of a hypertensive 55-year-old man with an acute isolated pupillary-sparing left CN III palsy from a left subgaleal abscess with associated pterional osteomyelitis and frontotemporal mass. This is the first reported such case and the third reported case of a chronic spontaneous subgaleal abscess. A seemingly routine case of an acute, pupillary-sparing, isolated CN III palsy from hypertension turned out to be a rare case in terms of etiology of the palsy and of the source of the abscess.
Cranial Nerve III ; palsy ; ptosis ; ophthalmoplegia