Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
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Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : NC19 - NC23 Full Version

Clinical Profile of Non Strabismic Binocular Vision Anomalies in MBBS and Nursing Students in a Teaching Hospital: A Cross-sectional Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55946.16478
Rohit Pratap Tiwari, Rakesh Kunverji Barot, Vrushali Sawant, Urvi Wagh, Bhavana Maknikar, Manjusha Kanetkar

1. Assistant Professor, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH, Kalwa, Thane, Maharashtra, India. 2. Professor, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH, Kalwa, Thane, Maharashtra, India. 3. Assistant Professor, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH, Kalwa, Thane, Maharashtra, India. 4. Junior Resident, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH, Kalwa, Thane, Maharashtra, India. 5. Junior Resident, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH, Kalwa, Thane, Maharashtra, India. 6. Junior Resident, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH, Kalwa, Thane, Maharashtra, India.

Correspondence Address :
Dr. Rohit Pratap Tiwari,
Flat No. 406, Krishnanagari, Building No. 2, Khadakpada Circle, Kalyan (West)-421301, Maharashtra, India.
E-mail: drrohitptiwari@gmail.com

Abstract

Introduction: Bachelor of Medicine and Bachelor of Surgery (MBBS) and nursing students spend a lot of time in near vision activities daily while studying. In the Coronavirus Disease-2019 (COVID-19) and post pandemic era, the emphasis on electronic teaching and studying has increased immensely. Students have started depending more on online studying, teaching and search for study material leading to more time being spent using electronic devices like mobile phones, tabs, Personal Computer (PC), etc. This can lead to lot of eye strain (digital eye strain) and this predisposes them to develop Non Strabismic Binocular Vision Anomalies (NSBVA) related to accommodation and convergence of eyes.

Aim: To study prevalence of NSBVA and report associated ocular symptoms and association of electronic devices (mobile, laptop) use with prevalence NSBVA, in MBBS and nursing students of a teaching hospital in Western Maharashtra.

Materials and Methods: This study was a cross-sectional observational study conducted between November 2020 to April 2021 at Rajiv Gandhi Medical College and CSM Hospital, Thane, Maharashtra, India. In this study, a total of 110 students including both MBBS and nursing students from all academic years of the hospital were examined for a comprehensive ophthalmic examination and complete binocular vision assessment. The prevalence of NSBVA, associated ocular symptoms, prevalence of refractive errors and duration of electronic device use in the students was documented. Student’s t-test was used to compare the total daily duration of electronic devices (mobile, laptop, computer tablets) use between students with and without NSBVA. Chi-square test was used to find association of variables duration of electronic device use and occurrence of NSBVA.

Results: Out of 110 students examined, there were 37.27% (n=41) were males and 62.72% (n=69) females. Age range was 18-30 years with mean age 21.85±2.67 years. Overall, 47 (42.72%) students had NSBVA including 34 MBBS and 13 nursing students. 12 (11%) students had ocular symptoms with NSBVA while 35 (31.8%) students had NSBVA without any ocular symptom. Eye strain was the most common ocular symptom. Average electronic device use was 4.53 hours/day. Most used electronic device was mobile phone. There was no association between NSBVA and electronic device use.

Conclusion: The NSBVA is highly prevalent among MBBS and nursing students. Ocular symptoms are absent in many students with NSBVA which may lead to delayed diagnosis and worsening of ocular symptoms due to NSBVA. Older age group of students have higher prevalence of NSBVA. Electronic device exposure is not significantly associated with NSBVA in these students. Screening of such at risk population is important for timely diagnosis and treatment of NSBVA.

Keywords

Accommodation excess, Convergence insufficiency, Electronic device, Eye strain

When we read and change fixation to near vision task, our eyes converge i.e., move inward and the focusing power of eyes increases i.e., eyes accommodate. Both these convergence and accommodation mechanisms should work harmoniously together for carrying out near and distant tasks. An imbalance between these mechanisms leads to a group of disorders clubbed under category of Non Strabismic Binocular Vision Anomalies (NSBVA) (1). NSBVA can be accompanied by symptoms like eye strain, headache, blurry vision and inability to focus on near objects, making it difficult for individuals to perform daily tasks (2),(3). These anomalies maybe asymptomatic but if left untreated or undiagnosed for long time, they can deteriorate into manifest strabismus.

In recent times, emphasis on near tasks like reading, desk work and use of electronic devices like computers, mobiles, has increased immensely. This can put undue stress on accommodation and vergence mechanisms of eyes, increasing risk of NSBVA. A high percentage of computer users are reported to have binocular vision problems which can worsen with prolonged computer use (4).

In COVID-19 pandemic times, students from all academic fields have relied more on use of devices like smart phones, computers, computer tablets for studying, attending lectures and internet surfing. Medical and nursing students are more likely to be exposed to such prolonged near tasks and use of such devices, exposing them to risk of developing NSBVA. Few studies on NSBVA in college students and school children have been conducted in past. To best of our knowledge, NSBVA in medical and nursing students and its association with electronic device exposure among them have not been studied. With this aim, the current study was conducted to know more about NSBVA in such at-risk group of student population.

Thus, the objectives of the present study were:

1. To find out prevalence of NSBVA and various ocular symptoms in MBBS and Nursing students of a teaching hospital.
2. To find association between use of electronic devices like mobile phones and laptops with occurrence of NSBVA in these students.

Material and Methods

This cross-sectional study was conducted from November 2020 to April 2021 at Rajiv Gandhi Medical College and CSM Hospital, Thane. The Ethical Clearance from the Institutional Review Board and Ethics Committee of the hospital (RGMC/CSMH/IEC/A/392/2020).

The study adhered to the Tenets of Declaration of Helsinki. The MBBS and nursing students of the hospital willing to participate in the study were examined in Ophthalmology Outpatient Department after obtaining written informed consent.

Sample size calculation: Considering the average prevalence of binocular dysfunction to be 33% from the study by Porcar E (5), and precision/absolute error of 9%, sample size was estimated to be 104 by using Cochran formula (5).

Inclusion criteria: All MBBS and nursing students who were willing to participate in the study were included in the study.

Exclusion criteria: Students with manifest squint or history of squint surgery, any intraocular diseases, students with history of any other intraocular surgeries like cataract surgery were excluded from the study.

Study Procedure

The students were subjected to detailed history taking about any asthenopic symptoms like headache, eye strain, blurring of vision, watering of eyes while reading/ studying and while using electronic devices like mobile phones, computers. Students were also asked in detail regarding the number of hours of use of devices like mobile phones, laptop, computer tablets per day and duration of regular use. Following this, all students underwent a comprehensive ophthalmic evaluation (including visual acuity, cycloplegic refraction, anterior segment examination of eyes of slit lamp and fundus examination) and binocular vision assessment by a single observer (RT). Binocular vision assessment was done with best corrected glasses if any.

Following parameters were assessed for binocular vision assessment (6):

1. Worth four dot test for distance and near
2. Phoria for near (at 40 cm) and distance at (6 meters) was measured with a prism bar
3. Accommodative Convergence: Accommodation (AC/A) ratio was measured by lens gradient method.
4. Near point of accommodation (NPA) and Near Point of Convergence (NPC). Average of three readings measured with Royal Air Force (RAF) rule (7).
5. Negative Fusional Vergence (NFV) and Positive Fusional Vergence (PFV) for near (at 40 cm) was measured was using prism bar by sequentially increasing strength of base-in and base-out prism and noting point of first blur and recovery.
6. Negative Relative Accommodation (NRA) and Positive Relative Accommodation (PRA) was measured as first sustained blur after sequentially increasing strength of positive and negative lenses.
7. Accommodation Facility Testing (AF) was done using standard accommodation rock cards and ±2 diopter accommodation flipper lenses both binocularly and uniocularly.
8. Monocular Estimation Method (MEM) retinoscopy was done using MEM card and streak retinoscope at 40 cm distance for assessing accommodation response.

The NSBVA anomalies include two types binocular anomalies and accommodation anomalies (Table/Fig 1), (Table/Fig 2), (Table/Fig 3) (6). Salient features of accommodation anomalies and binocular anomalies are presented in (Table/Fig 4), (Table/Fig 5) (6).

Statistical Analysis

The statistical analysis was done using the Statistical Package for Social Sciences (SPSS) software version 2022. Student’s t-test was used to compare the total daily duration of electronic devices (mobile, laptop, computer tablets) use between students with and without NSBVA. Chi-square test was used to find association of variable duration of electronic device use and occurrence of NSBVA. p-value <0.05 was considered statistically significant.

Results

A total of 110 students were examined which included 78 MBBS and 32 nursing students. Age of the students examined ranged from 18-30 years with mean age 21.85±2.67 years. Age of MBBS students examined ranged between 19-30 years age whereas nursing students ranged between 18-22 years age. There were 41 males (all MBBS students) and 69 females (including 37 MBBS and 32 nursing students) in the present study (Table/Fig 6).

Total 47 (42.27%) out of 110 students had NSBVA. Among MBBS students, 43.5% and among nursing students 40.6% had NSBVA (Table/Fig 7).

Prevalence of NSBVA was 41.17% in <20 years age-group, 40.29% in 21-25 years age-group and 66.66% in >25-30 years age-group (Table/Fig 8).

Most common NSBVA was accommodation excess found in 18.18% students. Second most common anomaly was Convergence insufficiency with secondary accommodation excess found in 8.18% (Table/Fig 9).

Range of ocular symptoms: Ocular symptoms were present in 26 (23.63%) students. Most common ocular symptom was eye strain seen in 19 (17.2%) students (Table/Fig 10). Total 12 students (10.90%) had ocular symptoms with NSBVA, 14 students (12.72%) had ocular symptoms without NSBVA whereas 35 students (31.81%) had NSBVA without ocular symptoms and 49 students (44.54%) had neither ocular symptoms nor NSBVA (Table/Fig 11).

Among students with NSBVA, the use of electronic devices per day ranged from 2-10 hours/day with a mean of 4.53±1.86 hours/day. Among students without NSBVA, electronic device use ranged between 1-8 hours/day with a mean of 4.36±1.52 hours/day. On comparing the daily duration (number of hours) of electronic devices use among students with and without NSBVA, using Student’s t-test, no significant difference was found (p-value=0.06059).

Overall, 63 students (57.27%) out of 110 had refractive error. Most common refractive error was simple myopia. A total of 21 students (44.68%) out of 47 students with NSBVA had refractive error and 42 students (66.66%) out of 63 students without NSBVA had refractive error (Table/Fig 12).

(Table/Fig 13) shows students grouped in different categories as per number of hours of exposure of mobile use/day. A total of 17 (36.17%) students out of 47 students with NSBVA and 30 (47.61%) students out of 63 students without NSBVA belonged to category of 3-5 hours/day of mobile use. On analysing this data from all categories, Chi-square statistic was 1.5586 with p-value of 0.458 showing no significant association of NSBVA with variable duration of hours of mobile use/day.

(Table/Fig 14) shows duration of regular mobile phone use in students with and without NSBVA. Chi-square test showed a p-value of 0.4399 indicating that there was no significant association of duration of regular mobile use with NSBVA.

Discussion

The MBBS and nursing students are involved in prolonged near tasks like reading, attending online lectures, research work, online exams, working on microscopes etc. Likewise, the use of devices likes mobiles, laptops, computer tablets has significantly increased in recent times. This can put an added stress on their accommodation and vergence mechanisms of eyes and can increase prevalence of NSBVA in them.

In the present study, 42.27% had NSBVA showing a significant prevalence of the anomaly in these students. However, the association between use of electronic devices use like mobiles and laptops with occurrence of NSBVA was not significant.

Atiya A et al., in a similar study done between April 2017 to November 2017, showed NSBVA in 41 (54.66%) out of 75 Ophthalmology trainees (8). Both these observations indicate a high prevalence of such anomalies in medical students especially those involved in significant near tasks.

Most common NSBVA found in the present study was Accommodation excess in 18.18% students while convergence insufficiency with secondary accommodation excess was second most common anomaly found in 8.18%. Atiya A et al., in their study found convergence insufficiency in 20% and accommodation infacility in 19% of Ophthalmology trainees in their institute (8). Dahal M and his colleagues, in a study on of NSBVA in Engineering students found accommodation insufficiency in 12.85% and convergence insufficiency in 11.42% of students (9). This shows that accommodation and convergence anomalies are commonly observed NSBVA among such students with high near task demands.

In the present study, 41.17% students among <20 years age group, 40.29% students between 21-25 years age group, 66.66% between 26-30 years age group were affected with NSBVA. This shows higher prevalence of NSBVA among older age group in the present study students. Magdalene D et al., in a similar study held in North-east India among patients with asthenopic symptoms, found prevalence of NSBVA as 69.35% in 10-20 years age group, 67.35% in 21-30 years age group and 50% in 31-40 years age group (1). As compared to Magdelene D et al., who showed 50% prevalence of NSBVA among 31-40 years age group, the present study showed 66.66% prevalence of NSBVA among 26-30 years age group (1). Hence, the present study showed that older age groups in medical field tend to have more prevalence of NSBVA as compared to those among general population.

In the present study, 10.9% students with NSBVA had ocular symptoms while 31.18% students had NSBVA without any ocular symptom. This indicates that ocular symptoms are frequently absent in NSBVA cases and such cases may go unnoticed for a long time before getting diagnosed. Screening of such at risk individuals can help in early diagnosis and treatment of NSBVA before the anomaly gets worsened and symptoms begin to manifest.

The difference with respect to number of hours of electronic devices use/day (like mobile, laptop, computer tablets) in students with and without NSBVA was not statistically significant. This finding is contrary to popular belief that excess mobile or other electronic device use might be associated with increased prevalence of NSBVA among students. Other factors like reading from non-electronic sources (books, journals, notes), other near activities involving frequent change of focus from near to distance and vice versa, family history of NSBVA, diet, systemic illnesses should also be considered before making such a comparison.

The present study showed 57.27% (63 out of 110) prevalence of refractive error in overall sample. 44.68% of students with NSBVA and 66.66% students without NSBVA had refractive errors. This showed a high prevalence of refractive errors in both groups. (Table/Fig 15) (8),(9),(10),(11),(12) shows various studies on NSBVA in different student population in recent times and most common anomalies found in respective studies. It is clear from this table that NSBVA is highly prevalent in student populations especially those with increased demands of near tasks.

Medical and nursing students have high visual demands. These demands increase when they move on from under graduate to post graduate career when they are involved into more clinical work and responsibility and also they have to read more and be involved in research activities. Many students are also involved in assisting in microscopic and laparoscopic surgeries and working on microscopes in labs which is an added ocular stress. The present study has found significant prevalence of NSBVA in under graduate medical and nursing students which can aggravate and become worse in their future career. Undiagnosed NSBVA can become decompensated causing worsened symptoms, decreasing work efficiency and poor job satisfaction. So, early diagnosis of such anomalies is very important in this group of population. It is suggested that evaluation of NSBVA should be a part of Ophthalmic evaluation in both undergraduate and postgraduate medical and nursing students for early diagnosis of NSBVA.

Limitation(s)

Small sample size was the limitation of the present study. Future studies should aim at larger sample size of medical students and focus on treatment outcomes of orthoptic exercises for NSBVA in such students.

Conclusion

Non strabismic binocular vision anomalies is highly prevalent among MBBS and nursing students with older age group being more affected. Many students with NSBVA do not show ocular symptoms, so the diagnosis of such anomaly may be delayed. Screening of students from medical and nursing background can help in timely diagnosis and treatment of NSBVA. There was no association of NSBVA with use of electronic device use in these students. Research aiming to study treatment outcomes of NSBVA in these students using vision therapy and orthoptic exercises is recommended.

Acknowledgement

Authors acknowledge the contribution by Dr. Vrushali Kulkarni, Assistant Lecturer from Department of Preventive and Social Medicine and Dr. Rohan Hire, Assistant Professor, Department of Pharmacology (contribution in statistics).

References

1.
Magdalene D, Dutta P, Choudhary M, Deskmukh S, Gupta K. Clinical profile of Non strabismic binocular vision anomalies in patients with asthenopia in North East India. TNOA J Ophthalmic Sci Res. 2017;55(3):182-86. [crossref]
2.
Bhardwaj G, Nasim P. Non strabismic Binocular vision anomalies: Whoosh the diagnosis. Acta Scientific Ophthalmology. 2020;3(2):02-04. [crossref]
3.
Sterner B, Gellerstedt M, Sjostrom A. Accommodation and the relationship to subjective symptoms with near work for young school children. Ophthalmic Physiol Opt. 2006;26(2):148-55. [crossref] [PubMed]
4.
Cooper JS, Burns CR, Cotter SA, Daum KM, Griffin JR, Scheimann MM. Care of patient with Accommodation and Vergence dysfunction. Optometric Clinical Practice Guideline. 2010; p-9. (cited Jan 2022). Available from: https://www.aoa.org/AOA/Documents/Practice/Management/Clinical/Guidelines/Consensus based guidelines/Care of Patient with Accommodative and Vergence Dysfunction.
5.
Porcar E. Prevalence of general binocular dysfunctions in a population of University students. Optometry and Vision Science: Official publication of the American Academy of Optometry. 199;74(2):111-13. [cited 2022 Jan 3]. Available from http://www.researchgate.net/publication/14120366_Prevalence_of_General Binocular_Dysfunctions_in_University_students. Doi: 10. 1097/00006324-199702000-00023. [crossref] [PubMed]
6.
Scheiman M, Wick B. Diagnostic testing. In: Clinical management of binocular vision: Heterophoric, accommodative and eye movement disorder. Philadelphia. Lippincott Williams and Wilkins, a Wolters Kluwer Business. 2014; 4th Edition.
7.
Sharma IP. RAF near point rule for near point of convergence-a short review. Ann Eye Science. 2017;2:16. Available from: http://dx.doi.org/10.21037/aes.2017.02.05. Doi: 10.21037/aes.2017.02.05. [crossref]
8.
Atiya A, Husaindeen JR, Kasturirangan S, Ramasubramanian S, Swathi K, Swaminathan M. Frequency of undetected binocular vision anomalies among Ophthalmology trainees. J Optom. 2020;13(3):185-90. [crossref] [PubMed]
9.
Dahal M, Kaiti R, Shah P, Ghimire R. Binocular vision Dysfunction among Engineering students in Nepal. Med Surg Ophthal Res. 2021;3(2).000559.
10.
Ali J, Sarkar S, Bakshi ZH. Screening of convergence disorders and accommodation disorders among school children in Gorakhpur. European Journal of Molecular and Clinical Medicine. 2020;7(10):2706-23.
11.
Mondal A, Soumiya. Prevalence of Non strabismic Binocular Vision Disorder in College Student. International Journal of Innovative Science and Research Technology. 2020;5(12):435-38.
12.
Darko-Tayki C, Owusu-Ansah A, Appiah-Eduenu C, Abu EK, Boadi-Kusi SB, Osei-Akoto Y. Refractive and binocular vision status in Optometry students, Ghana. Journal of Medical and Biomedical Sciences. 2016;5(2):24-29. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/55946.16478

Date of Submission: Feb 26, 2022
Date of Peer Review: Mar 26, 2022
Date of Acceptance: May 10, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 03, 2022
• Manual Googling: Mar 16, 2022
• iThenticate Software: May 06, 2022 (2%)

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