June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Ophthalmic Imaging and Impression Cytology Findings in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network
Author Affiliations & Notes
  • Tolulope Fashina
    University of Nebraska Stanley M Truhlsen Eye Institute, Omaha, Nebraska, United States
  • Sanjana Kuthyar
    Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, United States
  • Dianna Blau
    Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Mischka Garel
    Emory University Emory Global Health Institute, Atlanta, Georgia, United States
  • Richard Oliech
    Kenya Medical Research Institute, Nairobi, Kenya
  • Janet Agaya
    Kenya Medical Research Institute, Nairobi, Kenya
  • Jean-Claude Mwanza
    University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Amos Huachun
    University of Nebraska Stanley M Truhlsen Eye Institute, Omaha, Nebraska, United States
  • Prethy Rao
    Retina and Vitreous of Texas, Texas, United States
  • Hans E Grossniklaus
    Emory Eye Center, Atlanta, Georgia, United States
  • Kephas Otieno
    Kenya Medical Research Institute, Nairobi, Kenya
  • Victor Akelo
    Kenya Medical Research Institute, Nairobi, Kenya
  • Robert Breiman
    Global Health, Emory University School of Public Health, Atlanta, Georgia, United States
  • Jessica Shantha
    Francis I. Proctor Foundation for Ophthalmic Research, University of California San Francisco, California, United States
  • Steven Yeh
    University of Nebraska Stanley M Truhlsen Eye Institute, Omaha, Nebraska, United States
    Emory Eye Center, Atlanta, Georgia, United States
  • Footnotes
    Commercial Relationships   Tolulope Fashina None; Sanjana Kuthyar None; Dianna Blau None; Mischka Garel None; Richard Oliech None; Janet Agaya None; Jean-Claude Mwanza None; Amos Huachun None; Prethy Rao None; Hans Grossniklaus None; Kephas Otieno None; Victor Akelo None; Robert Breiman None; Jessica Shantha None; Steven Yeh None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 4471 – A0181. doi:
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      Tolulope Fashina, Sanjana Kuthyar, Dianna Blau, Mischka Garel, Richard Oliech, Janet Agaya, Jean-Claude Mwanza, Amos Huachun, Prethy Rao, Hans E Grossniklaus, Kephas Otieno, Victor Akelo, Robert Breiman, Jessica Shantha, Steven Yeh; Ophthalmic Imaging and Impression Cytology Findings in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4471 – A0181.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Under-five mortality (U5M) rate is disproportionately high in Sub-Saharan Africa. Prior studies have revealed an association between childhood blindness and U5M. Employing CHAMPS procedures which includes postmortem minimally invasive tissue sampling and testing, we studied the feasibility for eyes to provide supportive diagnostic information for determining etiologies of U5M.

Methods : Prospective assessment of the feasibility of photography and tissue sampling of postmortem eyes for identifying disease patterns correlating with ophthalmic disease and causes of U5M. Randomly selected cases of stillbirth and under-5 death from Kenya were enrolled. External, anterior, and posterior segment images were obtained with a portable camera, graded by 2 independent ophthalmologists, and adjudicated by a third ophthalmologist. Intra-class correlation coefficients (ICC) were calculated to determine the inter-rater reliability (IRR) of the grading scheme. Conjunctival specimens were obtained for impression cytology and molecular PCR detection of pathogens.

Results : Of 71 subjects (142 eyes) that underwent ophthalmic photography and standardized grading, external photos predominantly showed periorbital edema (16%), skin mottling (14%), ecchymosis (13%), and periorbital erythema (11%). Anterior segment findings were predominantly conjunctival injection (30%), corneal opacity (23%), and conjunctival icterus (16%). Posterior segment findings were predominantly macular whitening (51%), retinal fold (34%), and optic nerve pallor (9%). The ICC for posterior segment findings was 0.68, indicating moderate IRR. The ICC for external and anterior segment findings were < 0.50, indicating poor IRR for both measures.
Of 50 subjects (100 eyes) in which impression cytology was performed, goblet cells (78%), mucin spots (24%) and squamous metaplasia (5%) were observed. Other findings were acute inflammatory cells (4%), viral inclusions (4%), bacteria morphologies (7%), and fungal elements (3%).

Conclusions : In the postmortem assessment of causes of U5M, an ophthalmic surveillance protocol was implemented and feasible with moderate IRR for posterior segment findings on photography and gradable impression cytology specimens in most eyes assessed. Further studies of these diagnostics in relation to time-of-death may provide further insight into whether ocular findings may contribute to causes of U5M.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

 

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