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Purpose: Dry eye is a prevalent disorder of tear film resulting from either decreased tear production or increased tear evaporation. It is becoming a serious issue due to its disturbing symptoms, which become progressively troublesome affecting the work efficiency of patients and increasing financial burden due to lifelong dependency on eye drops. If not detected early, it can lead to sight‑threatening complications. This study aims to explore serum vitamin D3 deficiency as a causative factor of dry eye. Methods: The study was conducted in the outpatient department of a tertiary care hospital in India, for a period of two years from September 2018 to September 2020. About 40 patients who had dry eye and 20 controls were enrolled in this study. They were given an Ocular Surface Disease Index (OSDI) questionnaire, examined for signs of dry eye on slit lamp with Schirmer’s test and tear film break‑up time. All 60 participants were subjected to serum vitamin D3 level laboratory test and its deficiency prevalence was correlated with dry eye and its severity. Results: Serum vitamin D3 deficiency was found to be more prevalent in patients with dry eye. There was no gender predilection or change in prevalence with increasing age. Vitamin D3 level was negatively correlated with OSDI and positively with Schirmer’s test 1 and 2 and tear film break‑up time (TBUT) scores. Conclusion: The prevalence of vitamin D3 deficiency was not consistently found to be associated with the increasing severity of dry eye. [ABSTRACT FROM AUTHOR]

Introduction: Meibomian glands are holocrine meibum secreting glands driving out the oil from the orifice. It forms the outermost lipid layer of the tear film which prevents overflow of tears because of its hydrophobic properties and reduces their evaporation. The deficiency of oily layer of the tear film leads to evaporative dry eyes and ocular surface diseases. As Meibomian Gland Dysfunction (MGD) is one of the major causes of evaporative dry eye, with the help of this study, prevalence and association of MGD and dry eye can be evaluated and treated. Aim: To find out the prevalence and association of MGD and dry eye as well as asymptomatic individuals having MGD and dry eye in 30-80 years age group in the region of central Gujarat, Western India. Materials and Methods: This cross-sectional study was conducted in the Out Patient Department (OPD) of a Rural Tertiary care hospital in central Gujarat, India between February 2020-February 2021, after taking approval from Institutional Ethics Committee. Study included 389 subjects representing rural population of Anand, Gujarat, India. Subjects were asked for symptoms of dry eye according to Ocular Surface Disease Index (OSDI) questionnaire and severity of symptoms was assessed. Comprehensive ophthalmic examination including Best Corrected Visual Acuity (BCVA), Schirmer's test, slit lamp examination including conjunctival and corneal surface staining, Tear Film Break Up Time (TBUT), evaluation of meibomian gland orifices, lid margin anatomy, meibum expressibility, quality of meibum, meibomian gland dropouts was done. On the basis of these parameters, diagnosis and grading of MGD and dry eye was done. Subgroups were made according to age, gender, comorbidities (diabetes mellitus, hypertension, thyroid disease), cases of any refractive eye surgery, pseudophakic eyes, use of systemic drugs, hormonal pills, topical antiglaucoma drugs and use of contact lens. Data analysis was done by descriptive statistics (using Stata software 14.2 version). Analysis of Variance (ANOVA) were used to assess the association and Pearson test was applied to assess the correlation of MGD scores and dry eye severity with age. Results: Overall prevalence of MGD and dry eye were 97.4 % and 88.82% respectively. Out of all, 219 (56.3%) participants were asymptomatic. Age was significantly correlated with MGD and dry eye severity. Higher MGD scores were found with increase with dry eye severity. Highest MGD scores were observed when the tear break up time was <5 seconds. Conclusion: The prevalence of MGD and dry eye was high in the region of central Gujarat, India. MGD leads to deficiency of oily layer of the tear film leading to evaporative dry eyes and ocular surface diseases. [ABSTRACT FROM AUTHOR]

Background: The burden of dry eye in Indian patients with type 2 diabetes mellitus is not well documented. Methods: A hospital-based cross-sectional clinical study was conducted in a tertiary healthcare centre in Eastern Odisha on 100 T2DM patients from January 2017 to January 2019 to study the burden of dry eye. A detailed history of presenting symptoms, duration, progression and any associated condition, if present, were recorded. A detailed history regarding diabetes mellitus and treatment was recorded. The assessment of dry eye symptoms of patients was made using a questionnaire. The comprehensive ocular surface evaluation examination included visual acuity, and anterior segment examination included corneal surface, height of tear meniscus, pre-corneal tear film, tear film break-up time (TBUT) and Schirmer's test. Results: Their mean age was 53.7 ± 9.8 years; there were 54 were males. Sixty-two patients had complaints of dry eye. Mild, moderate and severe dry eye were noted in 31, 22 and 9 patients, respectively. Twenty-six patients with mild dry eye disease were noted with glycosylated haemoglobin HbA1c (%) levels between 6.1 and 7, and eight patients with severe dry eye disease had HbA1c 8%. TBUT was found to decrease as the severity of dry eye increased. Conclusions: In the present study, a strong association was found between T2DM and dry eye. It is necessary to examine the ocular surface routinely in DM patients for early detection of dry eye and prevention of structural damage to the ocular surface. [ABSTRACT FROM AUTHOR]

Allergic conjunctivitis (AC) is commonly associated with dry eye. This study was conducted to assess the prevalence of dry eye in different subsets of AC patients. Methods: This observational, cross‑sectional study, conducted in the Department of Ophthalmology of a tertiary center in north India, included 132 patients of AC. The diagnosis of dry eye disease (DED) was made on the basis of Ocular Surface Disease Index (OSDI), Schirmer’s test, and tear film break‑up time (TFBUT). Results: The prevalence of dry eye in AC patients was found to range between 31% and 36%. On OSDI scoring, 20.45% of patients had mild, 18.18% moderate, and 31.81% had a severe grade of DED, respectively. The mean OSDI score was noted to be significantly higher in patients with perennial allergic conjunctivitis (PAC) (29.82 ± 12.41), followed by seasonal allergic conjunctivitis (SAC) (25.35 ± 12.88), and least in the patients of vernal keratoconjunctivitis (VKC) (13.60 ± 8.63) (p < 0.0001), respectively. The TFBUT was found to be less than 10 s in 45.45% of PAC, 30.43% of SAC, and 20% of VKC patients, respectively. The difference between the mean TFBUT among the three groups was statistically insignificant (p = 0.683). Schirmer’s test value of <10 mm was observed in 45.45% of PAC, 43.47% of SAC, and 10% of VKC patients, respectively. Conclusion: This study revealed a high prevalence of DED in patients with AC. Among the different types of AC patients, PAC had the highest percentage of DED followed by SAC and least in VKC, respectively. [ABSTRACT FROM AUTHOR]

Introduction: Dry Eye Disease (DED) is a multifactorial disease which causes ocular discomfort and visual disturbances. It is one of the major causes of patients’ visit to the clinic. The prevalence of DED has increased in recent times due to increased time spent on computers and mobile phones, ageing population and highly stressful social environment. Various studies done in past on DED prevalence have given the variable results. Aim: To determine the prevalence of DED and analyse the associated risk factors in a tertiary care centre in Sonepat, Haryana, India. Materials and Methods: Present study was a cross-sectional observational study done in outpatient Department of Ophthalmology at Bhagat Phool Singh Government Medical College for Women, Sonepat, Haryana, India, from April 2021 to December 2021. Total 820 patients, aged >18 years were administered Ocular Surface Disease Index (OSDI) questionnaire. Patients with OSDI score >12 and positive one or both of the dry eye objective tests of Schirmer’s and Tear film Break Up Time (TBUT) below cut-off value were labeled as DED and were evaluated for association with various risk factors. Data were statistically analysed by Chi-square test, Wilcoxon-Mann-Whitney U test and Fisher’s exact test. Results: The mean age of patients were 39.65±15.52 years ranging between 18-79 years. DED was found to be more prevalent in females 120 (56.1%) compared to males 94 (43.9%). The prevalence of DED was 26.1% (214/820). Maximum prevalence was found in the age group 18-40 years (43.9%). Out of the 214 DED patients, 113 (52.8%) had mild, 95 (44.4%) had moderate and 6 (2.8%) had severe dry eye. The risk factors significantly associated (p<0.05) with DED were: more than 3.71 hours of Visual Display Terminal (VDT) use, occupational VDT users, homemakers, previous ocular surgery, uncorrected refractive error, diabetes mellitus, hypertension, Chronic Obstructive Pulmonary Disease (COPD), alcohol intake and mask use. Conclusion: DED is a significant cause of ocular morbidity, affecting more than quarter (26.1%) of the study population. Awareness and identification of risk factors for dry eye which are occupational VDT users, previous ocular surgery, uncorrected refractive error, diabetes mellitus, hypertension, COPD, alcohol intake and mask use is important for effective prevention and management of DED. [ABSTRACT FROM AUTHOR]

Prior studies show infrastructural improvements impact property values positively. The effect is often reflected soon after the announcement and continues until the project is complete. These studies, however, are primarily set in developed countries. Emerging markets pose unique risks where uncertainty around implementation and funding could dampen these positive effects significantly. We utilize a quasi-natural experiment around an inner-city road redesign and improvement project in Bangalore, the fastest growing city in India. We exploit the difference-in-difference regression approach to examine the project's impact on residential and commercial property values around two sets of geographically proximate roads, one of which was chosen for the redesign. Unlike in developed countries, we find that property values are unaffected by the announcement when uncertainty is the highest but start reflecting the positive value of the infrastructure once construction starts and show significant gains upon completion. Our findings carry important policy implications for structuring value capture strategies in emerging markets. [ABSTRACT FROM AUTHOR]

Objective: To investigate the intraocular pressure (IOP) lowering effect of topical preserved tafluprost 0.0015% in a tertiary hospital setting in India. Methods: This is a retrospective chart review of patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) attending regular outpatient visits in December 2019 and January 2021, and treated with topical preserved tafluprost 0.0015%. Based on their medication history, patients were divided into two groups, the "treatment naïve" group and the "switched" group, which included patients switched to tafluprost monotherapy after treatment with at least one prior drug. Results: The mean IOP of the study population reduced significantly from baseline level by 20.6% and 25.5% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The mean IOP in patients with only OHT reduced significantly from baseline level by 21% and 26% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The mean IOP in patients with POAG reduced significantly from baseline level by 19% and 24% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The baseline IOP ± SD in POAG treatment naïve patients was 25.3 ± 0.3 mmHg, which reduced significantly by 24% and 28% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The baseline IOP ± SD in POAG switched patients was 24.3 ± 0.1 mmHg, which reduced significantly by 18% and 22% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). In the POAG switch group, the percent reduction in IOP at 3 months after preserved tafluprost 0.0015% treatment was 23% with timolol as first line, 22% with bimatoprost as first line, 20% with latanoprost as first line, and 19% with travoprost as first line (P < 0.001 for all). Conclusions: We show significant IOP reduction with preserved tafluprost 0.0015% in a real-world setting. As first-line monotherapy in patients with OHT and in POAG–naïve patients, preserved tafluprost 0.0015% significantly reduced IOP at 3 months. Even as second-line therapy in nonresponders (POAG-Switched) to various drugs (same class [PGAs] versus different class), treatment with preserved tafluprost 0.0015% resulted in significant IOP reduction at 3 months. [ABSTRACT FROM AUTHOR]

Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is known to be proliferative, relapsing inflammatory disorder affecting mainly skin and other parts of body. There are several co-morbidities associated with psoriasis, of which ocular findings go unnoticed. Aim: To study the spectrum of ocular manifestations in psoriasis patients in Srikakulam, north coastal region of Andhra Pradesh, India and also to identify relationship between frequency of ocular involvement in psoriasis patients with age, gender, type and severity of psoriasis. Materials and Methods: The present cross-sectional study was conducted from March 2019 to March 2021 at Great Eastern Medical School and Hospital, Ragolu, Srikakulam, Andhra Pradesh, India. The study included 80 psoriasis patients attending dermatology Outpatient Department (OPD) to know various ophthalmological manifestations. Detailed dermatological examination was done followed by ophthalmological examination. Clinical types of psoriasis, site of involvement, and the severity of the disease using Psoriasis Area and Severity Index (PASI) were noted. Statistical analysis was done using Z-test, Pearson's correlation coefficient and linear regression coefficient. Results: Out of 80 patients with psoriasis, 51 (63.75%) were males and 29 (36.25%) were females. Out of total 80 patients, 56 (70%) patients had ophthalmic manifestations. The mean age of presentation was noted to be 49.22±8.53 years with range from 18-76 years. Most of the patients i.e. 30 (54%) had bilateral manifestations in both the eyes. Nearly 10 (18%) of psoriasis patients had multiple ocular manifestations. The p-value was calculated based on PASI score and with ocular manifestations which was found to be 0.0485 and was statistically significant. Conclusions: Regular screening of psoriasis patients is useful in identification of ocular problems which may not be noticed by the patients until symptomatic. [ABSTRACT FROM AUTHOR]

Introduction: Combination of various commensal microorganism species is capable of protecting the ocular surface from colonization by potentially pathogenic microbes. These homeostatic microorganisms can be easily altered by environmental factors like cataract surgery. These may play a role in the development of postcataract surgery Meibomian Gland Dysfunction (MGD) whose exact pathogenesis is still unknown. Aim: To assess the change in aerobic bacterial flora of meibomian glands and conjunctiva and its association with the development of MGD after cataract surgery. Materials and Methods: This prospective study was conducted in Department of Ophthalmology at BPS Government Medical College for Women, Sonepat, Haryana, India, from June 2021 to February 2022. A total of 60 eyes of 60 patients who had undergone uncomplicated phacoemulsification surgery with intraocular lens implantation were selected. Conjunctival and Meibomian Gland (MG) secretions samples were collected preoperatively before starting antibiotics and at 6 weeks postoperatively. Aerobic bacteria isolated from the culture samples of patients before and after surgery were analysed for microbial flora change (MFC). At 6 weeks postoperative follow-up visit, the diagnosis of the MGD was made on slit lamp examination of lid margin and meibomian glands. Chi-square test was applied to assess the association between patients with MFC and patients with MGD. results: There were 33 males and 27 females, with a mean age of 62.41 years. Preoperative conjunctival samples of 20 patients (33.33%) and MG samples of 27 patients (45%) were culture positive for aerobic bacteria. Most common microorganism isolated from preoperative samples was Coagulase Negative Staphylococci (CoNS). Isolation rate of Staphyloccus aureus increased postoperatively in both conjunctival and MG culture samples. Postoperative aerobic Microbial Flora Change (MFC) in culture samples of either conjunctival or MG or both was present in 30 patients (50%). Total 16 patients (26.6%) developed MGD out of which 13 patients (81.25%) had MFC. The association between MFC and MGD was statistically significant (p-value=0.004). conclusion: There is alteration of ocular aerobic bacterial flora after cataract surgery and it has a statistically significant association with postcataract surgery MGD. Replenishment of ocular surface microflora can play a preventive and therapeutic role in the management of postcataract surgery MGD. [ABSTRACT FROM AUTHOR]

BACKGROUND: The prolonged usage of digital displays leads to visual strain and, in turn, impairs psychological well-being. The practice of Yoga is said to enhance psychological functions and reduce visual strain. OBJECTIVE: The present study assessed the effect of the trataka (Yogic visual concentration) practice on the visual strain, mind-wandering, and mindfulness. METHODS: One hundred six volunteers equally distributed in the experimental and control groups completed the study. Visual Fatigue Scale (VFS), visual symptoms checklist (VSC), mind-wandering questionnaire (MWQ), and State Mindfulness Attention Awareness Scale (SMAAS) were administered at baseline and at the end of two weeks. RESULTS: All variables were similar at the baseline in both groups, and significant differences were noted at the end of two weeks between both groups. There was a significant reduction in VFS and VSC scores, MWQ, along with an increase in SMAAS scores in the experimental group. Although there were significant changes in VFS, MWQ, and SMAAS in the control group, the magnitude of change was minimal. CONCLUSIONS: The practice of trataka was found to reduce the visual strain, mind wandering while improving the state mindfulness. The practice can be implemented to mitigate visual strain and associated psychological implications due to prolonged exposure to digital displays, which has increased during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Rosacea is a chronic inflammatory disease that affects the facial skin with eye involvement being underdiagnosed. Aim: To study the prevalence of ocular rosacea in patients of rosacea in a tertiary care centre. Materials and Methods: The present study was a cross-sectional study conducted at two tertiary level hospitals from January 2020 to December 2021. Cases of rosacea diagnosed were referred from the Departments of dermatology to the Departments of ophthalmology for ocular evaluation. A total of 400 patients were included in study in a multicentric setting. For ophthalmic evaluation, Ocular Surface Disease Index (OSDI) questionnaire was used. Results: Total 29 cases (7.25%) had ocular rosacea, out of 400 dermatological confirmed cases of rosacea. Amongst confirmed ocular rosacea, 12 (41.4%) were males and 17 (58.6%) were females. Most manifestations were noted in 41 to 60 years age with an average age of 52.2 years. Most of the cases presented with multiple symptoms and signs- 19 presented with features of dry eyes, 16 had features of conjunctivitis, 6 had blepharitis, and 7 had recurrent chalazions. Conclusion: Ocular rosacea is a diagnostic enigma to clinicians as it is underdiagnosed because of overlapping sign and symptoms. This study emphasises ocular examination in all cases of rosacea. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy, safety, and tolerability of lifitegrast 5% versus carboxymethylcellulose (CMC) 0.5% in adult patients with dry eye disease (DED)., Methods: A total of 370 eligible patients with DED were randomized equally to receive twice-daily doses of a single drop in each eye of either lifitegrast 5% or CMC 0.5% for 12 weeks. Follow-up at weeks 2, 6, and 12 evaluated changes from baseline in primary [eye dryness score (EDS), ocular discomfort score (ODS), ocular surface disease index (OSDI), and tear film break-up time (TFBUT)] and secondary [Schirmer tear test (STT) score and corneal fluorescein staining (CFS) score] endpoints. Global improvement, safety, and tolerability were also assessed., Results: At week 2, values of ocular discomfort score, OSDI, and conjunctival redness were significantly more favorable in patients treated with lifitegrast compared to CMC. At week 6, values of all study variables were better in patients treated with lifitegrast compared to CMC; differences between the groups were statistically significant for all except photophobia. This trend was also maintained at week 12. Global improvement and tolerability were found to be better with lifitegrast than with CMC. No serious safety concerns were reported in any treatment group., Conclusion: To our knowledge, this is the first active-controlled trial informing on the efficacy, safety, and tolerability of lifitegrast 5%. Significantly more favorable values for EDS (except photophobia), ODS, OSDI, TFBUT, STT score, CFS score, and conjunctival redness score were achieved at week 12 with lifitegrast 5% compared to CMC 0.5%., (Copyright © 2024 Indian Journal of Ophthalmology.)

Purpose: To study the ophthalmologic manifestations of systemic sclerosis (SSc) and its correlation with autoantibody profile., Methods: A cross-sectional study on 200 eyes of 100 consecutive adult patients diagnosed with SSc was performed at a tertiary care center in Northern India. The examination of ocular adnexa, anterior segment, and posterior segment with slit-lamp biomicroscopy, tear film break-up time (TBUT), Schirmer's II test, and choroidal thickness measurement by swept-source ocular coherence tomography was done. Autoantibody profile was available for 85 patients, and its statistical association with the ocular examination findings was analyzed., Results: In total, 100 patients (93 females and 7 males) were included. The mean age was 45.11 ± 11.68 years, and the mean disease duration was 6.93 ± 3.68 years. Meibomian gland disease was more commonly found in patients with the diffuse subtype of SSc ( P = 0.037). Choroidal thickness was increased in 34% and decreased in 7% (reference range = 307 ± 79 µm) patients. Reduced TBUT, meibomian gland dysfunction, and eyelid stiffness had a statistically significant association with the presence of anti-Scl-70 antibody ( P = 0.003, <0.0001, and 0.004, respectively). These patients had ocular fatigue, foreign body sensation, and burning sensation. No significant association was noted with the presence of SS-A/Ro and SS-B/La antibodies., Conclusion: This study highlights the need for an active comprehensive ophthalmic evaluation. Approximately 75% of the patients in our cohort had ocular involvement to varying extent. An isolated presence of anti-Scl70 antibody was also found to have a positive association with dry eye disease., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)