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ARVO 2024: Using objective measures to gauge activity levels of visually-impaired children

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New research findings presented at this year's ARVO meeting compare two groups of paediatric patients in Nepal

This year's ARVO meeting is uniting vision experts from around the world in Seattle, Washington, for 5 days of fascinating programming. Ahead of her presentation, we spoke to Dr Srijana Adhikari, Head of Pediatric Ophthalmology and Strabismus at Tinganga Institute of Ophthalmology in Kathmandu, Nepal. Watch the video, or read the transcript below, to learn more about her research and its implications in future studies.

Editor's note: The below transcript has been lightly edited for clarity.

Hattie Hayes: Hi! My name is Hattie Hayes, and I'm the editor of Ophthalmology Times Europe. This year's ARVO meeting is in Seattle, and we here at the Eye Care Network are speaking to attendees about what they are presenting at the meeting and the data they're most looking forward to sharing. Joining me today I have Dr Srijana Adhikari. We're going to talk about her presentation, which is titled "Differences in objective physical activity between children with visual impairment and normal sight." Thank you so much for joining me today. I really appreciate it.

Dr Srijana Adhikari: Thank you. Thank you so much for inviting me.

HH: Go ahead and just give me a brief overview of your presentation and what you're going to be discussing at this meeting.

SA: This presentation of mine is a part of my PhD project, which I'm doing on blind and visually impaired children. So in this whole project, we are looking at the participation, activities, sleep patterns and quality of life of children, visually impaired children. At the same time, we are comparing these outcomes with the normally-sighted children. And so in this particular presentation, I'm presenting on the activity part...What we did was, we recruited children. In Nepal, there is an integrated system of education. Blind children also study in the same schools as normal sighted children. So we took children, the blind and visually impaired children, and for and from the same grade and from the same class, we chose their friends, the normally-sighted friends, for the control group. And in those children, we studied activity: types of activity, different parameters, levels of activity, by using objective measures, like actimeters.

HH: Among these data you've collected, is there anything that surprised you, or anything you think that your colleagues might find surprising?

SA: Yes, yes. What we found is that...in studies on measuring the activity in children, most of these studies are from the patient-reported outcomes. Those are the, the subjective studies. But my study is one of the very few studies which was done by using the actimeters. And what we found is that we divided the activities into different levels, like sedentary activity, mild and light physical activity, moderate and vigorous physical activity. And at the same time, we compared them during the different times of the day, which is also very unique of our study. Before school, what are what are their activities? During school, after school and during the weekend time? So what is the difference between visually-impaired and normal-sighted children? Well, what we found was that before the school time, before they start the school day, in the morning, the visually-impaired children were slightly more active than the normal-sighted children. And during school time, the normal-sighted children were more active, more physically active, than the visually-impaired children. But after school and during weekend time, both were the same...both were involved in, most of the time, sedentary and then low-to-moderate type of activity.

So, what we found was overall, in all children, the sedentary activity was more. It shows that the children are not very active, not as recommended as by WHO criteria. That was one thing we found. And we found that most of the visually-impaired children, during the morning hours, were active. So why was this? Well, in Nepal, most of the visually-impaired children stay in hostel, and then they are in a boarding school. [In comparison] normally-sighted children live with their parents and they come [to school] from home. So the children who stay in the hostel, they do their own morning activities. They get dressed up, they may prepare breakfast, and all these things by themselves. They are trained like that, and they have to do all those things [independently]. But at the same time, the children who stay with their parents, most of the things are done by the parents...That may be the difference. That was one thing that we really found very interesting. And because children who get involved in all these activities, light activities, are more active.

But, however, during school time, the normally-sighted children were more physically active than the visually-impaired children, which, we think, is [because] there are so many barriers...The playgrounds of the schools were very good, they have assigned physical activity classes for all the children, but still, the children with visually impairment have less opportunities. And maybe there are some barriers, like, they don't have games that are suitable for them, like dancing, gymnastics, swimming. Those those things needs to be given, the opportunity should be given, to [play] those types of games, for visually-impaired children. They cannot freely play football, basketball, or something like that. So that was a very interesting thing we found.

We thought that maybe the next step we can do with this research is [ask], What is the actual barrier? Whether they are provided or not provided with the sports or the activities that they should be taking part in, or they don't have any trained teachers, or they have lack of motivations, or maybe some pressures from the parents or from themselves that they might get injured or something like that, that is the yet to see. But these are very interesting things that we found.

HH: That's really interesting. Now, I know that, you know, ophthalmology is a field that's rapidly changing. And I think that you feel that more acutely in the pediatric sphere. What do you think will be the biggest change in pediatric ophthalmology in the next 10 years or so?

SA: I think that myopia is one of the very, very important things that is very much going on. We see so many people [being diagnosed with myopia], especially after the COVID period. Many children in our daily practice, and data also shows the same thing. So I think there will be research still going on, and more will come, for myopia progression, that will be a big change, that what I think. Another thing is...visual rehabilitation. Because [retinopathy of prematurity] ROP is also very much...coming up. Especially on our part, there it never used to be so much ROP. We never used to many ROP patients. But these days, because of the survival [rates] of neonates, and many other factors like IVF and all these things, prematurity is also increasing. At the same time, it's bringing ROP also. And the survival is increasing. So ROP, I think, is also the next big thing...in ROP, I feel that [we'll see] so many easier treatments. Before, there used to be only lasers and cryo, and now Avastin is there. So maybe more, simpler forms of treatment, and at the preventive level, also that will come up. There will be so many things that will make the lives of these visually impaired-children easier in next 10 years to come.

HH: My final question is the fun one: What are you most looking forward to at this ARVO meeting?

SA: This is my first ARVO! Though I have been to the US before many times, in APOS meetings and in other times, but for ARVO, it's my first time. I'm really looking forward to so many things about it, because right now I'm involved in research so I will go to all of them–I mean, as far as possible, I'll go to all the lectures which are of an interest to me...And I'm staying with my friends, so we'll have fun at the same time.

HH: Well, congrats on your first ARVO, and I hope that you have an absolutely wonderful time. Thank you for speaking with me today. I really appreciate it.

SA: Thank you, thank you so much.

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