Search

OBJECTIVE: To assess the effectiveness of a 3D-printed custom mask fitter in lieu of N95 respirators among ophthalmologists and other eye care professionals who may not be prioritized to receive N95 respirators amidst the coronavirus disease 2019 pandemic. METHODS: This was a proof-of-concept study from a tertiary eye care center in Oakville, Canada. All participants underwent the N95 Qualitative Fit Test with a custom mask fitter secured over an American Society for Testing and Materials Level 3 face mask. Participants answered a 10-point Likert scale questionnaire on comfort, ease of use, and feasibility of the custom mask fitter, as well as comfort of a regular face mask. RESULTS: Twenty participants were recruited. Of the 20 recruited, 18 (90%) successfully passed the fit test. The median scores for comfort, ease of use, and everyday feasibility for the custom mask fitter were 3.5, 4.5, and 3, respectively, whereas the median score for comfort of a regular face mask was 8.5. CONCLUSION: A reusable, low-cost, 3D-printed custom mask fitter is a potential effective alternative to an N95 respirator among eye care professionals but may require improvement in its design and comfort. This is especially relevant in the context of a limited supply of N95 respirators amidst a global pandemic.

Purpose To evaluate the agreement between glaucomatous 24-2 visual field (VF) testing performed with the Toronto Portable Perimeter (TPP; VEM Medical Technologies) and the Humphrey Field Analyzer (HFA; Carl Zeiss Meditec). Design Multicenter prospective cohort analysis. Participants Patients with suspected or confirmed glaucoma treated at Prism Eye Institute (Oakville, Canada), York Finch Eye Associates (North York, Canada), or the Ontario Mobile Medical Eye Care Unit (Cochrane, Canada) between March 2019 and March 2020. Methods Patients underwent consecutive VF tests on the same eye using the HFA Swedish Interactive Threshold Algorithm Standard 24-2 test and TPP Standard 24-2 test in randomized order. Bland-Altman analysis and paired t tests were used to compare VF results obtained by the TPP and the HFA. Participants completed a 5-question validated questionnaire after completing both testing methods. Main Outcome Measures Mean difference and degree of agreement in mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and test duration between VF modalities. Results One hundred fifty eyes from 91 patients were included in analysis. Average MD of the overall cohort using HFA and TPP VF testing was –4.32 ± 5.47 dB and –4.53 ± 5.22 dB, respectively (P = 0.74). Bland-Altman analysis showed good agreement between HFA and TPP tests. The mean differences (95% limits of agreement) between HFA and TPP for MD, PSD, VFI, and test duration were 0.21 dB (–4.25 to 4.67 dB), –0.13 dB (–3.72 to 3.47 dB), 0.66% (–10.94% to 12.26%), and 0.65 seconds (–97.51 to 98.81 seconds), respectively. No statistically significant mean difference was found between HFA and TPP tests for MD, PSD, VFI, or test duration. Mean deviation (R2 = 0.830) and VFI (R2 = 0.866) were correlated strongly with both modalities. Questionnaire results demonstrated that patients significantly preferred the TPP over the HFA for VF testing (P Conclusions Mean deviation, PSD, and VFI outcomes measured by the TPP were statistically similar to corresponding parameters obtained with the HFA. Test time duration did not differ significantly between the TPP and HFA, and patients significantly preferred the TPP to the HFA examination experience. These pilot results suggest that the TPP may offer an accessible alternative to HFA VF testing.

Purpose To evaluate the clinical and microbiological features of a large cohort of culture-confirmed fungal endophthalmitis across India. Design Cross-sectional hospital-based retrospective medical records review. Participants Seven large tertiary eye care centers from different regions of India. Methods The patient data were pooled from the electronic/physical medical records of each participating center. Fellowship-trained vitreoretinal specialists clinically managed all patients, and in-house microbiology laboratories performed all microbiology work-ups. The clinical and microbiology procedures were broadly uniform across all participating centers. The essential treatment consisted of vitreous surgery and intravitreal and systemic therapy with antifungal agents. Main Outcome Measures Clinical outcome by the causative event and causative fungus. Results In the 2005-2020 period, seven centers treated 3830 cases of culture-proven endophthalmitis, and 19.1% (n=730) were culture-confirmed fungal endophthalmitis. It included 46.9% postoperative (87.4% post-cataract surgery), 35.6% traumatic and 17.5% endogenous endophthalmitis. The fungi included 39.0% Aspergillus (high in central, east and south zones), 15.1% Candida (high in west zone), 15.9% Fusarium (high in north and west zone). The time to symptoms was between 1w-4w in more than a third of patients except in traumatic endophthalmitis. Less than half of patients had hypopyon on presentation. Presenting visual acuity (PVA) in most patients was 20/400 in 30.5% (n= 222) eyes; > 20/40 in 7.9% (n=58) eyes; and 12% (n=88) eyes lost light perception. Post-hoc analysis showed significantly more males in traumatic than post-operative (p Conclusions Fungal endophthalmitis is not uncommon in India. The inclusion of antifungal agents with antibiotics as the first empirical intravitreal therapy before microbiological confirmation could be considered when fungal infection is suspected

Purpose To develop and evaluate the performance of a 3-dimensional (3D) deep-learning–based automated digital gonioscopy system (DGS) in detecting 2 major characteristics in eyes with suspected primary angle-closure glaucoma (PACG): (1) narrow iridocorneal angles (static gonioscopy, Task I) and (2) peripheral anterior synechiae (PAS) (dynamic gonioscopy, Task II) on OCT scans. Design International, cross-sectional, multicenter study. Participants A total of 1.112 million images of 8694 volume scans (2294 patients) from 3 centers were included in this study (Task I, training/internal validation/external testing: 4515, 1101, and 2222 volume scans, respectively; Task II, training/internal validation/external testing: 378, 376, and 102 volume scans, respectively). Methods For Task I, a narrow angle was defined as an eye in which the posterior pigmented trabecular meshwork was not visible in more than 180° without indentation in the primary position captured in the dark room from the scans. For Task II, PAS was defined as the adhesion of the iris to the trabecular meshwork. The diagnostic performance of the 3D DGS was evaluated in both tasks with gonioscopic records as reference. Main Outcome Measures The area under the curve (AUC), sensitivity, and specificity of the 3D DGS were calculated. Results In Task I, 29.4% of patients had a narrow angle. The AUC, sensitivity, and specificity of 3D DGS on the external testing datasets were 0.943 (0.933–0.953), 0.867 (0.838–0.895), and 0.878 (0.859–0.896), respectively. For Task II, 13.8% of patients had PAS. The AUC, sensitivity, and specificity of 3D DGS were 0.902 (0.818–0.985), 0.900 (0.714–1.000), and 0.890 (0.841–0.938), respectively, on the external testing set at quadrant level following normal clinical practice; and 0.885 (0.836–0.933), 0.912 (0.816–1.000), and 0.700 (0.660–0.741), respectively, on the external testing set at clock-hour level. Conclusions The 3D DGS is effective in detecting eyes with suspected PACG. It has the potential to be used widely in the primary eye care community for screening of subjects at high risk of developing PACG.

PURPOSE: To characterize long-term clinical outcomes of monotherapy selective laser trabeculoplasty (SLT) in Afro-Caribbean patients with open-angle glaucoma (OAG). DESIGN: This was a post hoc analysis of nearly 8 years (median 3.2, interquartile range 2.1–7.1) of pooled data from the West Indies Glaucoma Laser Study (WIGLS) and its preliminary study. METHODS: SETTING: Three eye care practices in Saint Lucia and Dominica. PARTICIPANTS: Afro-Caribbean adults with mild-moderate OAG treated with ≤2 medications (61 in preliminary study, 72 in WIGLS). INTERVENTION: Participants underwent medication washout, baseline IOP determination, and bilateral 360° SLT. Participants were followed for up to 94 months. Repeat SLT was performed according to pre-specified criteria. MAIN OUTCOME MEASURES: The primary outcome was mean intraocular pressure (IOP) reduction from baseline. The secondary outcome was medication-free survival with SLT repeated as needed. RESULTS: The pooled data set included 265 eyes of 133 Afro-Caribbean participants. Mean (standard deviation) baseline IOP was 21.2 (3.4) and 21.2 (3.9) mmHg in right and left eyes, respectively. Over 8 years, mean IOP ranged from 12.8–15.7 mmHg and from 13.1–15.8 mmHg, respectively (p

CLINICAL RELEVANCE Nunavik Inuit patients, in Northern Canada, have a significant burden of refractive error. The frequency at which they access eye care is insufficient. This exposes children of this population to a substantial risk of refractive amblyopia. BACKGROUND No data are available on eye health and services among Nunavik Inuit in Quebec, Canada. This study aims to describe the prevalence of ametropias, risk of refractive amblyopia, and eye health services uptake amongst a sample of Nunavik Inuit. METHODS Retrospective cohort using data from electronic records of the sole government-contracted eye team travelling to all 14 Nunavik villages, from 2006 to 2018. RESULTS Some 26,541 examinations were analysed, with data from 6,341 patients (median age 27 years (IQR 30); 32% aged under 19 years; 60.3% female) representing 48% of the census population. Population weighted prevalence of ametropias was myopia 46.5% (95% CI 45.3 - 47.6), hyperopia 17.1% (95% CI 16.2 - 18.1), astigmatism 39.6% (95% CI 38.4 - 40.8) and presbyopia 30.0% (95% CI 28.9 - 31.0). Some 5.9% of patients aged 0-9 years present a risk of refractive amblyopia. Mean frequency of examinations for all ages was once per 4 years (95% CI 4.0 - 4.0) and for children aged 5 - 19 years, frequency was once per 4.8 years (95% CI 4.8 - 5.0). In 2018, 74% of patients who were prescribed spectacles purchased them, with a median time of procurement of 21 days (IQR 247, skewness 2.7). CONCLUSION There is a high prevalence of ametropias amongst the clinical population of Nunavik Inuit. Most patients needing spectacles obtain them within a few weeks. Frequency of eye health services is insufficient to meet recommended guidelines, especially in children, for whom the risk of refractive amblyopia is pervasive.

Purpose: To evaluate attitudes and perceptions toward virtual health (VH) and its usage among eye care providers before, during, and after the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: In April and May 2020, an online survey comprised of questions regarding past and current VH practices, as well as plans for future use was distributed among eye care providers nationwide. Results: Of the 117 eye care providers who completed the survey, 96.6% were not using VH before the COVID-19 pandemic. In contrast, 77.4% reported using VH during the pandemic. The majority of visits were for red eye (64.4%, n = 56) and ocular surface complaints (58.6%, n = 51). Examination components tested virtually varied, but most respondents felt these were at least "somewhat reliable." Almost half of respondents (45%) felt it was "very easy" or "somewhat easy" to implement VH and the majority (53.8%, n = 43) were able to get it up and running in under a week. The majority felt the transition to VH was positive (57.5%), however, only 50.4% (n = 53) of those providers planned to use VH regularly once able to see patients safely in clinic again. Conclusions: While the majority of U.S. eye care providers who responded were not using VH before the COVID-19 pandemic, just months into the U.S. outbreak, 77.4% were using VH in their daily practice. In general, providers used these platforms for urgent examinations, adnexal disease, and postoperative care most often. The majority felt the transition was a positive one, however, only half planned to continue regular use of VH once the pandemic ended.

BACKGROUND/OBJECTIVES To characterise the patterns of presentation and diagnostic frequencies in Hospital Emergency Eye Care Services (HEECS) across 13 hospitals in England. METHODS Retrospective, cross-sectional, observational multi-centre (n = 13) study to assess HEECS attendances over a 28-day study period. Data derived included: number of consecutive attendances, patient demographics and diagnoses. Age and gender variations, the impact of day of the week on attendance patterns, diagnostic frequencies and estimates of the annual incidence and attendance rates were evaluated. RESULTS A total of 17,667 patient (mean ± standard deviation age = 49.6 ± 21.8 years) attendances were identified with an estimated HEECS annual new attendance rate of 31.0 per 1,000 population. Significantly more females (53%) than males (47%) attended HEECS (p

BACKGROUND Fundus fluorescin angiography (FFA) has been traditional gold standard for detection of cystoid macular oedema (CME) but nowadays optical coherence tomography (OCT) is used more often by to detect CME due to various conditions. Although FFA can assess CME qualitatively, OCT provides quantitative measurement of foveal thickness. The purpose of this study is to compare sensitivity of FFA and OCT for detection of CME and know the etiological distribution of CME and the ability of FFA and OCT in diagnosing CME in different aetiologies. METHODS A hospital based prospective observational diagnostic study was conducted in tertiary eye care centre in central India on 143 eyes of 103 patients. FFA and OCT findings in patients of CME diagnosed provisionally on fundus examination were studied. RESULTS Of total 103 patients studied, maximum patients 20 (19.42 %) were in age group of 55 - 59 years whereas minimum 6 (5.83 %) were in age group of 40 - 44 years. In 103 patients, 61 (59.22 %) were males and 42 (40.78 %) were females. Both eyes were involved in 41 (40.78 %) cases. Most common cause of CME was nonproliferative diabetic retinopathy (NPDR) 52 eyes (35.86 %), followed by branch retinal vein occlusion (BRVO) 32 eyes (22.06 %), then proliferative diabetic retinopathy (PDR) 14 eyes (9.6 %), central retinal vein occlusion (CRVO) 13 eyes (8.96 %). CME on OCT was seen in maximum of retinal vein occlusion patients - CRVO (84.61 %) and BRVO (84.37 %). Of 145 eyes, 114 (78.32 %) eyes had CME. CONCLUSIONS Most common cause of CME was NPDR followed by BRVO, PDR and CRVO. Sensitivity of OCT in comparison with FFA was 100 % with diagnostic accuracy of 81.38 %. Hence, one can use OCT as first modality investigation for diagnosis of CME. KEYWORDS Optical Coherence Tomography, Fundus Fluorescein Angiography, Cystoid Macular Oedema, NPDR

Randall S Porter,1 Kathleen Holt,2 Rajeev S Ramchandran3 1Pediatric Ophthalmology and Ocular Genetics Service, University of Rochester Flaum Eye Institute, Rochester, NY, USA; 2University of Rochester Clinical & Translational Science Institute, Rochester, NY, USA; 3Retina and Vitreous Service, University of Rochester Flaum Eye Institute, Rochester, NY, USACorrespondence: Randall S PorterFlaum Eye Institute, Box 659, 601 Elmwood Ave, Rochester, NY, 14642, USATel +1 585 275-7039Fax +1 585 275-2352Email Randall_Porter@urmc.rochester.eduPurpose: The full utility of general health Patient-Reported Outcomes Measurement Information System® (PROMIS) surveys in the eye care setting has not been previously demonstrated. This report demonstrates the feasibility of implementing PROMIS in an eye care clinic.Patients and Methods: Over 2 months, general health and functioning PROMIS surveys were offered to all patients in an optometric clinic in Rochester, NY. Demographic and clinical variables were recorded along with percent completion and time to completion of the survey.Results: Across 651 patients, 258 chose to attempt PROMIS. Patients with low visual acuity were less likely to attempt the survey (p=0.049), and younger patients were more likely to complete the survey (p=0.025); no other patient characteristics were found to differ between those who did and did not participate in, nor complete, PROMIS. A total of 193 patients completed the survey (74.8%) in a mean time of 6.36 minutes (range = [1.43, 51.92] minutes; standard deviation = 5.62 minutes). Time to completion did not vary significantly across any groups.Conclusion: Our relatively high completion rate among those who attempted PROMIS indicates that PROMIS surveys are feasible to implement in an optometry clinic. While most patients completed the survey in little time, the large range of time to completion may indicate that some patients had difficulty completing the survey. Furthermore, the significant difference in visual acuity between those who participated in the survey and those who did not highlights the need to address the way PROMIS is delivered in order to foster greater inclusion.Keywords: patient-reported outcome, PRO, ophthalmology, optometry, clinic

There are close to two billion individuals globally living with presbyopia. In spite of its ubiquitous and progressive nature, there is no widely accepted, formal guideline or consensus statement on the classification of presbyopia by degree of severity. A panel of leading eye care professionals representing both optometrists and ophthalmologists convened virtually to discuss and document their combined assessments from the body of literature and clinical practice expertise in this commentary. In light of emerging therapies, classifying presbyopia by mild, moderate, or advanced severity may help provide consistency of diagnosis among eye care providers and may aid in managing patient expectations with different treatment options.

Background Over 700,000 New Zealanders (NZ), particularly elderly and Māori, live without timely access to specialist ophthalmology services. Teleophthalmology is a widely recognised tool that can assist in overcoming resource and distance barriers. Teleophthalmology gained unprecedented traction in NZ during the COVID-19 pandemic and subsequent lockdown. However, its provision is still limited and there are equity issues. The aim of this study was to conduct a systematic review identifying, describing and contrasting teleophthalmology services in NZ with the comparable countries of Australia, USA, Canada and the United Kingdom. Methods The electronic databases Embase, PubMed, Web of Science, Google Scholar and Google were systemically searched using the keywords: telemedicine, ophthalmology, tele-ophthalmology/teleophthalmology. The searches were filtered to the countries above, with no time constraints. An integrative approach was used to synthesise findings. Results One hundred and thirty-two studies were identified describing 90 discrete teleophthalmology services. Articles spanned from 1997 to 2020. Models were categorised into general eye care (n=21; 16%); emergency/trauma (n=6; 4.5%); school screening (n=25; 19%); artificial intelligence (AI) (n=23; 18%); and disease-specific models of care (MOC) (n=57; 43%). The most common diseases addressed were diabetic retinopathy (n=23; 17%); retinopathy of prematurity (n=9; 7%); and glaucoma (n=8; 6%). Programs were mainly centred in the US (n=72; 54.5%), followed by the UK (n=29; 22%), then Canada (n=16; 12%), Australia (n=13; 10%), with the fewest identified in NZ (n=3; 2%). Models generally involved an ophthalmologist consultative service, remote supervision and triaging. Most models involved local clinicians transmitting fed-forward or live images. Conclusion Teleophthalmology will likely play a crucial role in the future of eye care. COVID-19 has offered a unique opportunity to observe the use of teleophthalmology services globally. Feed-forward and, increasingly, live-based teleophthalmology services have demonstrated feasibility and cost-effectiveness in similar countries internationally. New Zealand's teleophthalmology services, however, are currently limited. Investing in strategic partnerships and technology at a national level can advance health equities in ophthalmic care.

The rheumatological diseases known as spondyloarthropathies (SpAs) are reviewed with respect to the current classifications of SpAs and from the perspective of ophthalmic practitioners. The focus is on the most common spondyloarthropathy, ankylosing spondylitis (AS), and the key symptoms, such as inflammatory back pain. The association with HLA-B27 and acute anterior uveitis (AAU) and the major clinical considerations for primary eye care practitioners are reviewed. An atypical case study illustrates difficulties in the detection and diagnosis of ankylosing spondylitis.

To determine the effect of lockdown on medical care, with the example of ophthalmology.Patients in a period during the first lockdown were compared to a non-lockdown period, with a total of 12 259 patients included in an observational study. Changes in different areas (elective, emergency, inpatients, surgeries) and eye care subspecialties were compared. Emergency patients were analyzed according to severity and urgency. Patients showing hints requiring treatment for urgent cardiovascular diseases were determined. Differences in patients who would have suffered severe vision loss without treatment were identified and the QALY (quality-adjusted life years) loss was determined accordingly. A model to prioritize patient visits after the end of lockdown or in future lockdown scenarios was developed. Data were collected at the University Eye Hospital LMU Munich and patient files were reviewed individually by ophthalmologists.The average patient number decreased by - 59.4% (p 0.001), with a significant loss in all areas (elective, emergency, inpatients, surgeries; p 0.001). There was a decline of - 39.6% for patients at high risk/high severity. Patients with indications of a risk factor of future stroke declined significantly (p = 0.003). QALY loss at the university eye hospital was 171, which was estimated to be 3160 - 24 143 for all of Germany. Working up high losses of outpatients during these 8 weeks of projected lockdown in Germany would take 7 - 23 weeks under normal circumstances, depending on ophthalmologist density. The prioritization model can reduce morbidity by up to 78%.There was marked loss of emergency cases and patients with chronic diseases. Making up for the losses in examinations and treatments will theoretically take weeks to months. To reduce the risk of morbidity, we recommend a prioritization model for rescheduling and future lockdown scenarios.Erfassung der Auswirkungen eines Lockdowns auf die medizinische Versorgung am Beispiel der Augenheilkunde.In einer Beobachtungsstudie wurden Patienten in einem Zeitraum während des ersten Lockdowns mit einem Zeitraum ohne Lockdown verglichen. Hierbei wurden insgesamt 12 259 Patienten eingeschlossen. Es wurden Veränderungen in verschiedenen Bereichen (elektive Fälle, Notfälle, stationäre Fälle, Operationen) und augenärztlichen Subspezialitäten verglichen. Notfallpatienten wurden nach Schweregrad und Dringlichkeit analysiert. Patienten mit ophthalmologischen Erkrankungen, die einen Hinweis auf behandlungsbedürftige, dringende kardiovaskuläre Erkrankungen darstellen, wurden ermittelt. Unterschiede von Patienten, die ohne Behandlung einen schweren Sehverlust erlitten hätten, wurden identifiziert und der QALY-Verlust entsprechend ermittelt. Ein Modell zur Priorisierung von Patientenbesuchen nach dem Ende des Lockdowns oder in zukünftigen Lockdownszenarien wurde entwickelt. Die Daten wurden an der Universitätsaugenklinik LMU München erhoben und die Patientenakten einzeln von Augenärzten geprüft.Die durchschnittliche Patientenzahl sank um − 59,4% (p 0,001) mit einem signifikanten Verlust in allen Bereichen (elektive Fälle, Notfälle, stationäre Fälle, Operationen; p 0,001). Bei Patienten mit hohem Risiko/hohem Schweregrad ergab sich ein Rückgang von − 39,6%. Patienten mit ophthalmologischen Erkrankungen, die einen Hinweis auf ein mögliches erhöhtes Risiko für einen zukünftigen Schlaganfall geben, nahmen signifikant ab (p = 0,003). Der QALY-Verlust an der Universitätsaugenklinik betrug 171, geschätzt für Deutschland 3160 – 24 143. Die Aufarbeitung der hohen Verluste an ambulanten Patienten während der 8 Wochen Sperrung würde auf Deutschland hochgerechnet unter normalen Umständen je nach Augenarztdichte 7 – 23 Wochen dauern. Das Priorisierungsmodell kann die Morbidität um bis zu 78% reduzieren.Es kam zu eminenten Verlusten sowohl bei Notfallpatienten als auch bei Patienten mit chronischen Erkrankungen. Das Aufarbeiten der verpassten Untersuchungen und Behandlungen wird theoretisch Wochen bis Monate dauern. Um das Morbiditätsrisiko zu reduzieren, empfehlen wir ein Priorisierungsmodell für die Wiedereinbestellung nach dem Lockdown und künftige Lockdownszenarien.

Introduction Vision health is an important and underutilized health service among newly arrived refugees in Canada, yet the body of literature on eye-care delivery in this population is limited. The study objective was to identify patterns of eye-care utilization among refugee patients with type 2 diabetes mellitus (T2DM) in Newfoundland and Labrador (NL) under an interdisciplinary clinic model comprised of family physicians, eye-care providers, and settlement services. Methods This was a retrospective cohort study at the Memorial University Family Medicine clinic. All patients with a new T2DM diagnosis between 2015–2020 were included. Data were described using basic statistics and unpaired t-tests. This study received full ethics approval. Results Seventy-three (18 refugee, 55 non-refugee) patients were included. Refugees had a higher rate of referral to an eye-care provider ( p = 0.0475) and were more likely to attend their eye-care provider appointment than non-refugees ( p = 0.016). The time from diagnosis to referral was longer for refugees than non-refugees ( p = 0.0498). A trend towards longer time from referral to appointment attendance for refugees than non-refugees was noted ( p = 0.9069). Discussion Refugee patients had higher rates of referral to eye-care providers and utilization of eye-care services. However, refugees also experienced a longer time to access vision screening services suggesting possible gaps in accessible care delivery. This suggests that the interdisciplinary model of care may be effective in referring refugee patients for vision screening and there may be a role for increased collaboration across family physicians, eye-care providers, and settlement services to improve accessibility of vision screening services.

To report on the factors associated with severe vision loss from fireworks-related ocular trauma during celebrations, including festivals. Tertiary eye care hospitals in 5 countries and private ophthalmology practices in the Netherlands. Patients included received treatment for fireworks-related ocular trauma during celebrations. Demographic and clinical data for patients affected were analyzed and associations with severe vision loss reported. Of 388 patients, 71 (18.3 %) had severe vision loss (worse than 6/60) at 4-week follow-up due to fireworks-related ocular trauma. Mean age overall was 20.6 years (range 2 to 83 years), and there was a male predominance of 4:1. Clinical factors associated with severe vision loss included penetrating injury (OR 4.874 [95% CI 1.298–18.304; p = 0.02]) and lens injury (OR 7.023 [95% CI 2.378–20.736; p = 0.0004]). More patients with closed-globe injuries (CGIs) had improved vision after 4 weeks (OR 3.667, 1.096–12.27) compared to those with open-globe injuries (OGI) (p = 0.035). Eye protection use was reported by 7 patients, and 39.4% patients < 18 years were unsupervised by an adult at the time of injury. Severe vision loss from fireworks-related ocular trauma occurred during celebrations in a variety of countries and was associated with penetrating and/or lens injury and poor presenting vision. New initiatives are needed to prevent severe vision loss associated with these injuries.

BACKGROUND Colour vision is a function of three types of cone pigments present in the retina. Colour vision deficiency is an important disorder of vision that may pose a handicap to the performance of an affected individual. The prevalence of colour blindness varies in different geographical areas. The identification and estimation of the prevalence of colour vision deficiency in school-going children will help to educate and guide the caregivers to help the children in selecting their profession. This study was done to estimate the prevalence, sex distribution, and types of colour vision deficiency among school-going children of 5 to 15 years. METHODS A cross-sectional observational study was done among 500 students to evaluate the colour vision during the period from 1st January 2018 to 30th June 2019 at the Regional Institute of Ophthalmology, Kolkata. Ishihara’s pseudo isochromatic colour vision chart 38th edition was used to assess the school children for colour vision status. The children who were found to be colour blind were further classified into degree and types of colour vision deficiency. RESULTS A total of 500 students (250 male & 250 female) of surrounding schools, in the age group of 5 years to 15 years, were screened. 480 students (96 %) had normal colour vision while 20 (4 %) students were found to have defective colour vision. Prevalence (4 %) for colour blindness was found to be higher in males (3.6 %) than females (0.4 %). It was observed that out of 20 (4 %) colour-blind subjects 3.6 % were protanopes and 0.4 % were deuteranopes. CONCLUSIONS The present study shows the prevalence of colour blindness found to be quite low (4 %) and more common in males (3.6 %) in comparison to females (0.4 %). Protanomaly (3.6 %) was more common than deuteranomaly (0.4 %). KEYWORDS Colour Blindness, Protanomaly, Deuteranomaly, School Children

To report the etiopathogenesis and clinical features of blepharoptosis in patients with thyroid eye disease. A 10-year retrospective interventional study. The etiopathogenesis, laterality, clinical features, and management of Blepharoptosis in thyroid eye disease (TED) were assessed. A total of 1000 patients of TED were evaluated in the 10-year period, of which 55 (5.5%) presented with Blepharoptosis. The average age at presentation was 44.8 years, and 31 (56.4%) were males. Of the 41 cases where referral diagnosis was available, TED was suspected in only 2 cases. Of the 55, 25 patients were inactive (TED duration ≥ 12 months), and 29 were silent presenters (TED duration ≤ 12 months, but clinical activity score ≤ 3). Ptosis was the primary presenting symptom in 14 cases. Ptosis was aponeurotic in 38 cases, myasthenic in 13 cases, congenital in 2 cases, and indeterminate in 2 cases. Orbital imaging was available in 26 cases, of which fat disease was noted in 14 cases. Average amount of ptosis was 2.21 mm (range 1-6 mm). Lower eyelid retraction (average 2.1 mm) was noted in 49 patients. Surgical management was performed in 10 patients, of which 4 underwent a unique combined surgery (orbital decompression with levator reattachment/resection). In patients with TED, blepharoptosis constitutes 5.5% at presentation to a tertiary eye care centre. Blepharoptosis masks upper eyelid retraction as a clinical sign of TED. Commonest cause was acquired aponeurotic ptosis. A combined levator surgery is possible with orbital decompression in such cases.

Background: Provision and uptake of low vision services are essential. Objective: To assess the availability of low vision services and barriers to their provision and uptake in the Ashanti and Brong Ahafo regions of Ghana from the perspective of eye care practitioners. Methods: A descriptive, quantitative, cross-sectional study design using semi-structured questionnaires was used to collect information from eye care practitioners selected from 58 eye care facilities in the Ashanti and Brong Ahafo regions of Ghana. Results: Forty-four eye care practitioners from Ashanti region and 10 from Brong Ahafo region responded to the question- naire. Seventeen (34%) of the 50 eye care facilities who reported having patients seeking low vision services in their facilities provided such services. Lack of low vision devices (94.4%) and equipment (87%) were reported to be the main barriers to the provision of low vision services. Major barriers to low vision services uptake were lack of awareness (88.7%), high cost (70.4%) and social unacceptability of low vision assistive devices (59.3%). Conclusion: Lack of adequate low vision services and barriers to their provision and uptake impact negatively on efforts to prevent visual impairment and blindness in Ghana. Keywords: Low vision services; provision; barriers.

Background Computers have become a fundamental part of clinical radiology departments. Radiologists tend to spend long hours in front of computers, reading and analyzing medical images. This prolonged use of computers is associated with digital eye strain. Therefore, this study aimed to estimate the prevalence of digital eye strain among radiologists and determine its contributory factors. Methods An online survey was sent to radiologists practicing in hospitals in the Eastern Province of Saudi Arabia. The survey addressed demographic information, workload and workstation environment, personal eye care, and evaluation of digital eye strain symptoms as well as the strategies employed to reduce these symptoms. Results were analyzed descriptively using Chi-square tests and logistic regression analyses. Results The survey was completed by 198 participants (111 men and 87 women), including residents (40.9%), senior registrars (27.3%), and consultants (27.3%). Most participants (71.2%) were aged below 40 years. Most participants tend to spend 7–9 hours daily reviewing medical images. Overall, 50 participants (25.3%) take a break from work once daily only. A total of 53 participants (26.8%) reported undergoing an eye examination within the past year and 100 participants (50.5%) reported experiencing digital eye strain. Multivariate logistic regression analysis revealed that female sex (odds ratio [OR] = 3.9; 95% confidence interval [95% CI]: 1.6–10.0) and the practice of taking breaks once a day (OR = 15.1; 95% CI: 2.4–94.1) or twice a day (OR = 5.5; 95% CI: 1.1–28.4) only were associated with higher rates of digital eye strain symptoms. Conclusion Digital eye strain is a prevalent condition among radiologists regardless of their subspecialty. It is more commonly seen among radiology residents. Being a female and not taking frequent breaks were associated with higher rates of digital eye strain.

Betelhem Temesgen Yibekal,1 Nebiyat Feleke Adimassu,1 Fisseha Admassu Ayele2 1Department of Optometry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar City, Ethiopia; 2Department of Ophthalmology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar City, EthiopiaCorrespondence: Betelhem Temesgen Yibekal Email betelhemtemesgen28@gmail.comBackground: Pseudoexfoliation syndrome is an age-related disorder characterized by the deposition of a distinct fibrillar extracellular material in various tissues and organs of the body. Glaucoma and cataract are the consistently reported clinical consequences of Pseudoexfoliation syndrome on the eye. This study aimed to estimate the proportion of pseudo-exfoliation syndrome and associated factors in Gondar university comprehensive specialized hospital tertiary eye care and training center.Methods and Materials: Institution-based cross-sectional study was conducted from January to March 2019 at Gondar university comprehensive specialized hospital tertiary eye care and training center among 295 patients. Consecutive 295 participants aged above 40 years were involved in the study. A structured questionnaire and ocular examination were used to collect the data. Data were entered into EPI-INFO 3.5.1 and exported to SPSS version 20 for analysis. Factors associated with pseudoexfoliation syndrome were ascertained by chi-square and independent t-test. Statistical significance was considered when p-value < 0.05.Results: A total of 295 adults participated in the study with a response rate of 92.8%. The median (±IQR) age of study respondents was 64(± 9) years and 67.8% were males. The proportion pseudoexfoliation syndrome was 34.6% [95% CI: 29.2– 40.7%]. The mean IOP and mean age were significantly higher among patients with pseudoexfoliation syndrome. Age, sex, high IOP, glaucoma, outdoor work, and rural residence were significantly associated with the proportion of pseudoexfoliation syndrome.Conclusion: The proportion of pseudoexfoliation syndrome among participants aged ≥ 40 years was high. Age, sex, high IOP, glaucoma, outdoor work, and rural residence were factors having a significant association with the proportion of pseudoexfoliation syndrome.Keywords: pseudoexfoliation syndrome, Ethiopia, Gondar

BACKGROUND: Certain occupations and career paths require potential candidates who meet certain visual standards that allow them to apply or hold realistic possibilities for career advancement. AIM: This study aims to assess the visual function requirements for public jobs in Saudi Arabia and compare them with international standards. METHODS: Interview with eye care specialists in the fields of optometry and ophthalmology was conducted. This interview was consisted of seven pre-approved questions on current vision health requirements for eyesight-dependent careers. RESULTS: Interview responses revealed the existence of several visual requirements which were visual acuity, color vision, and visual field. These requirements are essential for various government jobs and functions, with examinations of applicants being necessary for acceptance of a vacancy or subsequent career progression. CONCLUSION: Many government positions of employment require predefined level visual standards which are not widely known. Defining what these standards are and making them publicly accessible will aid both future candidates in better planning their employment options and specialists in providing the required standards on request.

PURPOSE The aim of this study was to report on the feasibility of setting up a system of corneal transplants at rural outreach centers and report the outcomes of the first 111 cases. METHODS Retrospective analysis of the outcomes of corneal transplantation performed on patients with optical indications between March 2016 and September 2019 at 4 secondary (rural) centers. The centers are a part of a network in the pyramidal model developed by L V Prasad Eye Institute. The graft clarity and best-corrected visual acuity (BCVA) at 1-year follow-up were analyzed. RESULTS Of the 111 patients, 34.23% underwent penetrating keratoplasty and 65.77% endothelial keratoplasty. The mean age was 59.4 ± 15.0 (range-17-86 years); 47.75% were men and 52.25% were women. The indications for surgery were bullous keratopathy (54.05%), corneal scar/adherent leukoma (23.42%), and repeat grafts (13.51%). At the end of 1 year, 69.37% grafts remained clear. Factors associated with graft failure included poor socioeconomic status and graft infiltrate in both univariate and multivariate analyses. Surgical technique of endothelial keratoplasty was associated with failure on multivariate analysis only. Of the 77 eyes with clear corneal grafts at 1 year, the preoperative mean logMAR BCVA was 1.91 ± 0.06, which improved to 0.90 ± 0.08 postoperatively. Overall, 84.4% had preoperative BCVA of

BACKGROUND Immediate sequential bilateral cataract surgery (ISBCS) is the procedure in which both eyes are simultaneously operated in a single hospital visit. The onset of corona virus disease-19 (COVID-19) pandemic has raised the interest among ophthalmic surgeon in considering immediate sequential bilateral cataract surgery to reduce hospital visit of patients. This study was done to assess the intraoperative and post-operative complications and average number of hospital visits required after performing immediate sequential bilateral cataract surgery in COVID-19 pandemic. Also, the post-operative visual outcomes were evaluated. METHODS Patients with visually significant bilateral cataract with best corrected visual acuity ≤ 6/18 in better eye, axial length within range of 21 - 25 mm and age >18 years with no ocular and systemic co-morbidity were included in the study. All patients underwent immediate sequential bilateral cataract surgery from July 2020 to September 2020. Strict intraoperative protocols were followed in all cases. Intracameral injection of 0.1 ml moxifloxacin 0.5 % (vigamox / Novartis health care Pvt Ltd. Texas, USA) was given at the end of surgery in all cases. Intraoperative and post-operative complications, visual and refractive outcomes were analysed. RESULTS Sixty-four eyes of 32 patients with mean age 55 ± 2.82 years (range: 48 - 71 years) were included in the study. The mean pre-operative best corrected visual acuity was 0.64 ± 0.08 logarithm of minimum angle of resolution which improved significantly to 0.03 ± 0.03 at the end of second follow up on day 14 (P < 0.0001). The mean post-operative spherical equivalent was -0.22 ± 0.48 D. The target refraction within ± 0.50 D was achieved in 56 eyes (87.50 %) and within ± 1.0 D in all eyes. No vision threatening complications such as endophthalmitis, cystoid macular oedema, retinal detachment or corneal decompensation occurred in any of eyes. Total hospital visits were reduced to four per patients for both eye surgeries. CONCLUSIONS Immediate sequential bilateral cataract surgery may be considered as preferred practice in selected cases to reduce the risk of cross infection of COVID-19 by short hospitalization and less follow up visits. KEYWORDS Bilateral Cataract Surgery, COVID-19, Endophthalmitis

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. Purpose: This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. Methods: A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. Results: Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33–2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28–1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67–2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74–3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. Conclusion: The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population.

BACKGROUND Optical Coherence Tomography (OCT) is a commonly used non invasive imaging instrument useful for the diagnosis and follow up of macular disorders, but it has its own share of drawbacks in the presence of media opacities like corneal oedema, dense cataract and vitreous haemorrhage. We wanted to study and interpret the various patterns of common macular diseases on optical coherence tomography. METHODS 100 patients having macular diseases with no other ocular pathology were selected by simple random sampling. The patients were studied and followed up from day 1 of OPD during the period from January 2019 to December 2019 in rural hospital at Latur. All patients suspected of any macular disorder by slit lamp bio-microscopy with 78D or 90D examination were subjected to OCT evaluation. RESULTS On observation, out of 100 cases of macular pathology, 44 % (44 patients) with age related macular degeneration(ARMD), diabetic macular oedema ( DME) 36 % (36 patients), central serous retinopathy (CSR) 10 % (10 patients), myopic maculopathy (MM) 7 % (7 patients), macular hole (MH) 3 % (3 patients) were found in our study. In ARMD patients our OCT findings were hard drusens in retinal pigment epithelium (RPE), detachment of neurosensory retina and retinal pigment epithelium whereas in patients of DME our OCT findings were cyst like hyporeflective spaces within the retina, with retinal thinning and loss of foveal depression. In patients of CSR our findings were separation of sensory retina from RP, in myopic maculopathy our OCT findings were presence of macular retinoschisis and in patients of MH our findings were showing attachment of the posterior hyaloids to the fovea, separation of a small portion of the sensory retina from RPE in the foveolar region and intraretinal cystic changes. CONCLUSIONS OCT plays a crucial role when added along with the clinical examination in the diagnosis and interpretation of common macular disorders. KEYWORDS Optical Coherence Tomography, Age Related Macular Degeneration, Macular Hole, Myopic Maculopathy

Purpose The intravitreal injection (IVI) of pharmacologic agents is the most commonly performed ocular procedure and is associated with a host of complications. Most IVI-related complications data are derived from randomized controlled clinical trials, which report a high adverse event rate. The nature of these protocol-driven trials limit their applicability to the diverse circumstances seen in routine clinical practice. The goal of this study was to determine the prevalence of patient-reported IVI-related complications, their risk factors, and the manner in which patients sought treatment at a tertiary eye care center. Design Retrospective, institutional review board–approved study. Participants Forty-four thousand seven hundred thirty-four injections in 5318 unique patients at the Cleveland Clinic Cole Eye Institute from 2012 through 2016. Methods Intravitreal injection. Main Outcome Measures Complication occurrence within 15 days of injection. Results From 2012 through 2016, a total of 44734 injections were performed in 5318 unique patients. Overall, complication rates were low, representing 1.9% of all injections, with 1031 unique complications in 685 patients (12.9%). The most common minor complications, or those not requiring intervention, were irritation (n = 312) and subconjunctival hemorrhage (n = 284). The most common serious complications, or those requiring intervention, were corneal abrasion (n = 46) and iritis (n = 31). Most complications (66%) were managed adequately by a telephone or Epic (Epic Systems Corp., Verona, WI) electronic message encounter only. Importantly, no injection protocol parameter, such as type of anesthesia, preparation, or post-injection medication, increased the risk of a complication. However, a patient’s gender, age, number of previous injections, and provider strongly influenced the risk of patient-reported complications. Conclusions Overall, complication rates seen in routine clinical practice were low compared with clinical trial reporting. Providers should feel confident in the safety and administration of IVI during times when follow-up office visits and resources may be limited. When performing an IVI, factors such as a patient’s gender, age, number of previous injections, and provider must be taken into account to ensure the best possible outcomes.

Introduction: In Nepal, females suffer from disproportionately higher burden of blindness and vision impairment with low access to eye care. The available knowledge is inadequate to address the issues related to gender and generate information to reduce the gender disparity. The aim of this study was to determine female clients’ satisfaction with services at eye facilities in Nepal and to estimate the cost of cataract surgery. Materials and methods: Exit interviews were conducted in 2018 with 308 female clients from eight facilities in five districts. Face to face interviews were conducted using a pretested semi-structured questionnaire adopted from the midterm review of Vision 2020. Results: The mean age of participants was 54±17 years. Ninety seven percent (97%) of the participants reported that they received service as per their expectation and were satisfied with the service of the facilities. Major factors for satisfaction were: thorough eye examination (54%), behavior of health staff (40%), and cleanliness of health facility (39%). Another eighty percent (80%) of the participants mentioned that they would recommend or return to the same facility. Fifteen percent of the participants perceived that they faced problems at the eye facility because of their gender. Around three quarters (73%) paid health expenses from their pocket. Most (83%) of the participants rated user fees as either reasonable or inexpensive. Conclusion: The majority of participants reported receiving service as expected and willingness to return to the same eye health facility for future consultation. However, most participants had to pay the health care expenses out-of-pocket.

Background: In 2016, Sight for All United (SFAU) was founded in the Mahoning Valley of Ohio with the mission of improving access to care and maximizing the visual potential of the underserved. Methods: A retrospective chart review was conducted on patients served by SFAU from January 2016 through August 2020. Socioeconomic information, type of service, cost, and dollar amount paid were collected for patients. The data were analyzed with descriptive statistics and mapped with Esri ArcGIS. Results: A total of 1327 patients received assistance through the medical assistance and school vision programs. In the medical assistance program, 222 patients (mean age 50 years, 57% female) completed applications and 37% (83 patients) were in a household of 3 or more people. Median yearly income was $18 504, 134% above the federal poverty level by household size. The most common surgical services were cataract surgery (101) and vitreoretinal care (17). The most common medical services were eye exams (79) and spectacles (76). Estimated value of medical services provided was $367 249; actual cost was $93 746. The school vision program provided 1105 eye exams, 1514 pairs of spectacles, and 1 cataract surgery with an estimated value of $133 692. Conclusion: Sight for All United provided $500 941 of vision services to its patients since 2016 while dispersing less than $100 000 of donated dollars through collaboration with eye care providers, community resources, and national foun-dations. This study demonstrates the impact vision foundations managed by local eye care providers can have on the needs in their community in a cost-effective and efficient way.

There is increasing focus on the value of real-world clinical registry data in multiple medical disciplines, including ophthalmology. However, disease-focused clinical registries that engage optometrists are rare. This paper introduces the Optometry Module of the Save Sight Keratoconus Registry (SSKR) and highlights the potential advantages it can offer to optometrists for improving their quality of patient care and for engaging in research. Optometrists are primary eye care providers and have a major role in providing clinical care to people with keratoconus. The SSKR system has been developed to collects high-quality information on essential clinical parameters including patient-reported outcomes (i.e., quality of life data). The real-world data from the Optometry Module of the SSKR can be analysed to obtain insights into contemporary optometry keratoconus practice, and be used to identify opportunities for improving clinical care. Optometrists' engagement with the registry supports reflective clinical practice through real-time benchmarking. Optometrists can use the registry system to track patient outcomes, and it provides a framework for educating patients about their keratoconus journey. The system also captures details relating to patient adverse events, with subsequent data analysis enabling risk factors for such events to be identified. In summary, the Optometry Module of the SSKR captures real-world clinical evidence that has the potential to inform practice improvement, facilitate safety surveillance and enable outcomes research in keratoconus, all with the ultimate intent of enhancing care for people living with keratoconus.

The novel COVID-19 pandemic, caused by the SARS CoV- 2 virus, has led to widespread public health concerns across the globe. Ophthalmology professionals may be susceptible to infection due to close patient proximity during slit lamp examination and the potential contamination of instruments. The knowledge, attitude, practice (KAP)study can provide an insight of ECPs’(eye care practitioners) knowledge, methods of practice and attitude during this pandemic. This helps to reduce their risk, and that of their family, of contracting the virus, reduce morbidity and mortality associated with being infected.Data and results obtained from this study can also be used to make emergency policies and implement them to stop the spread and impact of a similar outbreak in future.A cross-sectional study was conducted to evaluate the knowledge, attitude and practice of guidelines amongst the Eye care professionals towards the novel Covid-19. The demographic characteristics and infection rate of Covid-19 among the professionals during practice was also recorded and analyzed.In this hospital based cross-sectional study, total 67 eye care professionals including nurses, optometrist participated in the study with their due consent. Among total 67 participants, 60 (89.5%) were doctors, 4 (5.97%) were nurses and 3 (4.477) were optometrists All the participants including doctors, nurses and optometrists achieved a mean of 97.8% in the knowledge section of questionnaire.100% of the participants wear mask and maintain social distancing while all of them have received training regarding practice and management of patients during Covid19 and all the participants have a positive attitude towards the measure taken to combat Covid-19 pandemic.The eye care professionals participated in this study shows a good knowledge, positive attitude and practice of guidelines by the government of India are followed for the pandemic of Covid-19.

Across the United States, many patients, including veteran patients, face barriers in accessing appropriate, timely, and affordable healthcare. When developing or modifying healthcare systems to improve patient access, we can consider strategies (e.g., telehealth) in which lower-cost, more abundant resources are used for services often performed with more constrained and/or more expensive, specialized resources. We propose a framework in which hierarchical care networks allow patients to receive frontline care from lower cost, more accessible alternatives, while specialized resources are reserved for more complex care. We use operations research tools, including mixed-integer programming and facility location models, to design and analyze these networks. We present a case study applying these methods to improve veterans’ access to eye care screenings. The case study results demonstrate that using different providers in locations throughout the system can increase the number of patients screened by nearly four times the number currently screened while increasing the budget by only 2.5%. When designing healthcare networks to improve access, decision makers must consider several trade-offs, including how resources are distributed. Operations research tools are effective methods for understanding, designing, and evaluating these trade-offs to best understand the wide-ranging impacts of resource (re)distribution.

PRECIS Angle closure disease was present in 59.3% of eyes with long anterior zonules. The cause is multifactorial including a thick anteriorly positioned crystalline lens, shorter axial length and increased lens thickness to axial length factor. PURPOSE To study the profile of eyes with long anterior zonules (LAZ) presenting in a glaucoma clinic in a tertiary eye care centre and understand the pathogenesis of angle closure disease in these eyes. METHODS Retrospective cross sectional study.All patients with LAZ seen from January 2014-December 2018 were included. Demographic and clinical characteristics were noted. LAZ eyes (177 eyes of 177 patients) were compared with an equal number of age and gender matched controls. LAZ was defined as radially oriented zonular fibres (both pigmented and non pigmented), extending central to the normal zonular termination zone on the anterior lens surface more than 1▒mm beyond their usual insertion of 1.42±0.24▒mm from the lens equator onto the mid peripheral zone or central to it, as seen on slit lamp examination, following pupillary dilation by a single examiner. Glaucoma was defined according to the International Society for Geographical and Epidemiological Ophthalmology classification. The following biometric parameters were compared: anterior chamber depth (ACD), axial length (AXL), lens thickness (LT), lens position (LP=ACD+0.5*LT), relative lens position (RLP=LP/AXL); lens thickness to axial length factor (LAF=(LT/AXL)×10). LAZ eyes without angle closure disease were also compared with controls. RESULTS Mean age of patients with LAZ was 64.8±8.1 years. Of these, 63.3% were females. Angle closure disease was present in 59.3% (105 of 177) patients. Majority of these eyes were primary angle closure suspects (53.3%, n=56). Significant differences were found between LAZ eyes and controls for LT (4.8±0.38▒mm vs. 4.49±0.40▒mm P

Purpose The aim of this study was to evaluate differences in the iris and angle parameters in psuedoexfoliation syndrome (PXF) and pseudoexfoliation glaucoma (PXG) using anterior segment optical coherence tomography (ASOCT). Methods Patients with PXF or PXG were compared using ASOCT with primary open-angle glaucoma POAG eyes as controls in this noninterventional comparative study conducted at a tertiary eye care center in East India. All angle parameters, TM length, and iris thickness were analyzed from the enhanced depth imaging (EDI) single scans obtained. Quadrant scans were used for the calculation of iris volume using a custom-built in-house software. In particular, the software performs multiple operations including edge detection, connected components, and thresholding to localize and segment the iris. Differences in the iris volume/thickness and TM length in PXF and PXG with POAG were analyzed. Results A total of 225 eyes were included, which included 75 PXG and 98 PXF cases and 52 POAG with a mean age of 67 ± 9.7 years at presentation. The algorithm repeatability and reproducibility was also established with correlation coefficients more than 99% which was substantiated with Bland-Altman plots. The iris volume (calculated in 197 images of 225 eyes) did not differ significantly in PXF and PXG eyes, although both had significantly greater volume compared to POAG eyes. The iris volume or other angle parameters including TM length did not correlate with clinical variables such as IOP, age, or visual field indices. Conclusion Iris parameters or TM length do not explain pathogenesis of glaucoma in pseudoexfoliation.

Masresha Mengistu, Fisseha Admassu, Teshager Wondale, Asamere Tsegaw Department of Ophthalmology, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Asamere TsegawDepartment of Ophthalmology, College of Medicine and Health Sciences, University of Gondar, P.O.Box 196, Gondar, EthiopiaTel +251939912863Email asameret@yahoo.comPurpose: According to World Health Organization (WHO), cataract is the leading cause of blindness and visual impairment throughout the world. Post-operative refractive error is one of the commonest reasons for poor visual outcome after cataract surgery especially in developing countries where the standard modern biometry equipments are not available. The objective of this study was to assess the refractive outcome of cataract surgery done at University of Gondar (UoG) Tertiary Eye Care and Training Center, North West Ethiopia.Methods: A descriptive cross-sectional study was done on 66 patients who had undergone manual small incision cataract surgery (MSICS) and fulfilled the inclusion criteria at UoG Tertiary Eye Care and Training Center from July 15 2019 to October 15 2019.Results: From 90 post-operatively refracted eyes, 58 (64.4%) eyes achieved a target refraction of ± 1.00 Diopter (D). The right and left eyes achieved mean post-operative refraction SE of − 0.073± 1.45D and − 0.93± 1.70 D, respectively. But only 54 (60%) eyes were implanted with the calculated IOL power and for the remaining 40% the calculated IOL was not available at the store. And the target (Good) post-operative uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) was achieved in 66.7% and 82.2% eyes, respectively.Conclusion: The post-operative refractive outcome after cataract surgery at the center is low. For over one-third of operated eyes, the calculated IOL was not implanted due to the absence of the required IOL power at the store and, therefore, a wide range of IOL power should be available at the center.Keywords: cataract surgery, outcome, Gondar, Ethiopia

Samiksha Fouzdar-Jain,1 Zena Ibrahim,2 Jeremy Reitinger,3 Dingcai Cao,2 Mehmet C Mocan2 1Department of Pediatric Ophthalmology & Adult Strabismus, Children’s Hospital and Medical Center, Omaha, NE, USA; 2Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; 3Creighton University School of Medicine, Omaha, NE, USACorrespondence: Samiksha Fouzdar-JainDepartment of Pediatric Ophthalmology & Adult Strabismus, Children’s Hospital and Medical Center, Omaha, NE, USAEmail sjain@childrensomaha.orgPurpose: This study aimed to evaluate the visual outcomes of pediatric patients diagnosed with Peters anomaly (PA) in a tertiary eye care center.Methods: This was a retrospective study undertaken at a single academic center. Clinical records of pediatric patients diagnosed with PA from 2000 to 2017 were reviewed. Parameters recorded included visual acuity (VA), intraocular pressure (IOP), presence of glaucoma, and surgical procedures performed. The impact of PA type on final visual acuity levels was analyzed using generalized estimation equation models.Results: Twenty-one eyes from 11 patients were analyzed. At the final visit, 9 eyes (42.8%) had a VA ≥ 20/200, while 12 (57%) had < 20/200, ranging from 20/250 to no light perception. Of the study cohort, 15 (71.5%) eyes had type I, while six (28.5%) had type II PA. Glaucoma was present in 20 eyes (95%) at the final visit. One eye had dense central leucoma and microphthalmos where IOP could not be measured accurately. Seventeen eyes (81%) underwent at least one intraocular surgery, while the average number of surgeries per eye was 2.9 ± 2.5 (range=0– 9). The type of PA beta(se)=0.53 (0.41),p= 0.20] was not found to be a significant risk factor for worse VA.Conclusion: Severe visual impairment develops in the majority of patients with PA. The type of anomaly does not appear to be associated with a worse visual function in patients with PA. Glaucoma develops in a high percentage of this patient population, and thus close monitoring of IOP in this patient population is crucial.Keywords: Peters anomaly, penetrating keratoplasty, visual outcomes, logMAR, corneal opacity

6-6-2020 was a landmark date for the ophthalmology community, not only because of the normal visual acuity connotation of 6/6 and 20/20, but because it genuinely reflects every ophthalmologist’s dream to bring back perfect vision for every patient. The Covid-19 pandemic had forced ophthalmologists to “refuse to operate” albeit for a short period. This narrative describes how, during a telemedicine call, a surgeon experienced the distress of refusing to operate on a mature cataract. It reveals the trauma caused by the disordered goals of eye care during the pandemic, when elective procedures were abandoned and only emergency services were provided.

Introduction: We describe the microbiological profile of postoperative endophthalmitis from northern India and analyse the pattern of antibiotic sensitivity which may have changed due to development of resistance secondary to overuse of antimicrobial drugs. Materials and methods: This is a retrospective study of postoperative endophthalmitis from January 2011 to December 2017 in a tertiary eye hospital of northern India. Any patient developing endophthalmitis within one year of any intraocular procedure was included in the study. According to severity, treatment with a trial of intravitreal antibiotic injections or core vitrectomy was decided. Ocular samples were collected which were either anterior chamber tap or vitreous biopsy and sent for microbiological examination. The samples were stained with Gram’s and KOH stain and cultured on chocolate agar, blood agar, brain heart infusion broth and Sabouraud dextrose agar.Results: A total of 545 patients of postoperative endophthalmitis were analysed which showed a male predilection (60.5%) with maximum patients between the age group 50-69 years. 292 patients (53.5%) were culture negative and 253 patients (46.4%) were culture positive. Most common organism identified was Staphylococcus in 73 patients followed by Pseudomonas in 48 patients. Staphylococcus species was most sensitive to vancomycin (97%) followed by amikacin (91%) followed by gentamicin and moxifloxacin (88% each). Pseudomonas was the second most common isolate which showed maximum sensitivity to imipenem (82%) followed by ciprofloxacin(60%). Polymicrobial infection was noted in 23 patients. The most common fungal isolate was aspergillus in 11 patients, followed by fusarium in 10 patients. Conclusion: Our study shows that gram positive bacteria are the most common organisms in postoperative endophthalmitis and are most sensitive to vancomycin, followed by gram negative bacteria which show increased sensitivity with imipenem than commonly used antibiotic - ceftazidime.

BACKGROUND Open angle glaucoma forms a major proportion of glaucomas which is a leading cause of irreversible blindness worldwide. Anatomical variations in ocular structures and consequent secondary open angle glaucoma occurs in significant number of patients afflicted with pseudoexfoliation syndrome. Hence, a detailed workup and identification of glaucoma and appropriate management is essential to prevent further visual loss. We wanted to evaluate the incidence of open angle glaucoma among patients having pseudo exfoliation syndrome at Regional Institute of Ophthalmology, Trivandrum, Kerala. METHODS A cross sectional study comprising 142 individuals with pseudo exfoliation syndrome was conducted in Regional Institute of Ophthalmology, Trivandrum, Kerala, over a period of one year. Sociodemographic variables were collected through structured interviewer administered questionnaire followed by detailed ocular work up and visual field analysis. Data was analysed using Statistical Package for Social Sciences, SPSS 16. RESULTS Among 142 subjects, 70.4 % were males and 29.6 % were females. The mean age of participants was 65 years. In studied population, 83.1 % represented rural population. Incidence of open angle glaucoma among studied population with pseudoexfoliation was 10.56 % (95 % confidence interval; 5.50 % - 15.61 %). No case of normal tension glaucoma was identified during the study period. 29.57 % of subjects showed bilateral pseudoexfoliation. But among patients with pseudoexfoliation (PEX) glaucoma, 78.9 % had bilateral disease. Mean intra ocular pressure in eyes with PEX glaucoma was 27.38 ± 5.75 mm Hg and in PEX eyes without glaucoma was 23.20 ± 1.6 mmHg. Pupillary dilatation was observed to be less than the normal eyes and was 5.62 mm. 4 % of eyes with PEX had some form of zonulopathy. CONCLUSIONS Hospital based incidence of open angle glaucoma among patients with pseudo exfoliation is 10.56 %. KEYWORDS Pseudoexfoliation, Open Angle Glaucoma, Incidence, Intraocular Pressure, Gonioscopy

Introduction: Systemic acetazolamide is an efficacious adjunct to topical therapy to lower intraocular pressure (IOP) in glaucomatous eyes. This article aims to provide a comprehensive review for how best to use the agent in ophthalmic practice.Areas covered: This article will review the history, mechanism of action, methods of observing efficacy, indications for IOP lowering, side effects, allergy information including discussion of limited cross-reactivity between antimicrobial and non-antimicrobial sulfonamides, formulations, dosing and monitoring of acetazolamide. To select articles for this review, an electronic search was conducted using the PubMed database and cross-referencing was conducted for relevant literature.Expert opinion: The benefits of oral carbonic anhydrase inhibitor therapy can outweigh the risks in many circumstances. It is important that eye care practitioners work together with a patient's primary care practitioner to monitor for and mitigate risks. Greater education is needed with regard to the allergy profile of these powerful agents. Though not often a first-line option, oral carbonic anhydrase inhibitors remain pivotal and play in important role in delivery of eye care.

BACKGROUND: Patients presenting to emergency departments for ophthalmic emergencies benefit from prompt evaluation. However, Few emergency departments (EDs) have ophthalmologists on call, and eye care provided in EDs without ophthalmic services can be inaccurate. METHODS: We review the current state of ophthalmic telemedical care in EDs and highlight important considerations when implementing telemedicine in this setting. RESULTS: Telemedicine allows ophthalmologists to work with on-site emergency care providers to interview and examine patients remotely in EDs, enabling proper assessment of patient history, visual acuity, pupils, intraocular pressure, as well as the anterior and posterior segment. To date, patients' perceptions of this new model of care have been largely positive. DISCUSSION: The use of telemedical consultations for remote evaluation of patients with ophthalmic complaints stands to improve the quality of care provided to patients and extend the reach of remote ophthalmologists. The onset of the COVID-19 pandemic and the risk of in-person care further highlights the potential for telemedicine to augment existing models of emergency care.

To determine the effect of clinical and cytological features of ocular surface disease on patient’s satisfaction following small incision cataract surgery at a tertiary eye care centre. This is a prospective observational study of 70 consecutive consenting patients who underwent manual small incision cataract surgery(MSICS) at a tertiary eye care centre. All participants underwent ocular surface profile assessment using Schirmer I test (ST1), tear film break-up time (TBUT), conjunctival impression cytology (CIC) and ocular surface disease index (OSDI) at pre-operative visit, 1-week and 4-week post-operative visit. Patient’s satisfaction with surgical outcome was evaluated at 6-week post-operative visit using a rating scale of 1 to 10. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY USA). The mean age was 68 ± 9.4 years with a male/female ratio of 1:1.1. The mean OSDI score decreased significantly (p

Purpose The aim of this study was to compare the postoperative visual outcome after a Day 0 examination in patients with two follow-ups, one between Day 3 to Day 7 and other between Day 25 to Day 30 to those with a single ophthalmic follow-up directly after 25-30 Days and to assess the safety of deferral of the first follow-up visit at 1 week. Methods Randomized Controlled Trial was conducted at a tertiary eye care hospital, with 848 patients enrolled for the study. Patients meeting the inclusion criteria were selected. Their pre-operative and post-operative data was collected and the patients were divided into groups based on the type of cataract surgery and the postoperative follow-up protocol through randomization. Results No significant difference was observed in the postoperative visual outcome in patients that underwent postoperative review at Day 3-7 and Day 25-30 as opposed to those that followed up directly at Day 25-30 after a mandatory Day 0 examination for all patients. Conclusion In patients with no preexisting ocular or systemic comorbidity undergoing an uneventful cataract surgery, the postoperative follow-up visit can be safely deferred until 4 weeks, without any impact on the postoperative visual outcome, thereby conserving the available resources which can be deviated towards better eye care services.

BACKGROUND Posterior capsule opacification (PCO) is the most common delayed complication of cataract surgery. Nd:YAG (Neodymium yttrium aluminium garnet) laser posterior capsulotomy presents the advantages of a non-invasive, effective, relatively safe technique to manage intact posterior capsule that opacifies postoperatively. With this background we want to study the visual outcome and complications following Nd-YAG laser posterior capsulotomy in posterior capsular opacification following small incision cataract surgery (SICS). METHODS The study includes 64 patients attending outpatient department of a tertiary eye care hospital at Latur from June 2018 to May 2019 who have undergone SICS with PMMA PC IOL (polymethyl methacrylate posterior chamber intraocular lens) implantation and clinically diagnosed with posterior capsular opacification. 64 eyes with PCO were subjected to Nd:YAG laser posterior capsulotomy after detailed slit lamp bio microscopic examination pre- and post-capsulotomy. Follow-up was done at 1 hour, 1 week, 2 weeks and 4 weeks and patients were examined for visual outcome and any complications at each visit. RESULTS There were 16 males (25 %) and 48 females (75 %) with a mean age of 65 years. Posterior capsule opacification occurs within 3 years accounting for 46.9 % of the cases. Elschnig pearls type of PCO was more common when compared to fibrous type of PCO. Best corrected visual acuity (BCVA) before Nd:YAG laser capsulotomy was less than 6 / 60 in 35 patients (54.7 %) and within 6 / 60 to 6 / 24 in 23 patients (35. 9 %) with 6 patients (9.4 %) accounting for visual acuity between 6 / 24 to 6 / 18. After Nd - YAG Laser Capsulotomy, 46.9 % gained best corrected visual acuity of 6 / 18 or better, 39.1 % cases improved 6 / 12 and better and BCVA of 6 / 9, 6 / 6 was observed in 11 cases and 1 case respectively. Only 12 out of 64 patients had complications. Raised intraocular pressure (IOP) was found in 4 patients. Intraocular lens (IOL) pitting was found in 8 patients. CONCLUSIONS Nd:YAG laser capsulotomy is a safe, effective and a non-invasive procedure which avoids all the complications of surgical capsulotomy in patients of posterior capsule opacification. KEYWORDS Posterior capsule opacification (PCO), Nd:Yag Laser Capsulotomy, Best Corrected Visual Acuity (BCVA), Central Subfield Macular Thickness (CSMT)

Belantamab mafodotin (belamaf) demonstrated deep and durable responses in patients with heavily pretreated relapsed or refractory multiple myeloma (RRMM) in DREAMM-2 (NCT03525678). Corneal events, specifically keratopathy (including superficial punctate keratopathy and/or microcyst-like epithelial changes (MECs), eye examination findings with/without symptoms), were common, consistent with reports from other antibody–drug conjugates. Given the novel nature of corneal events in RRMM management, guidelines are required for their prompt identification and appropriate management. Eye examination findings from DREAMM-2 and insights from hematology/oncology investigators and ophthalmologists, including corneal specialists, were collated and used to develop corneal event management guidelines. The following recommendations were formulated: close collaboration among hematologist/oncologists and eye care professionals is needed, in part, to provide optimal care in relation to the belamaf benefit–risk profile. Patients receiving belamaf should undergo eye examinations before and during every treatment cycle and promptly upon worsening of symptoms. Severity of corneal events should be determined based on corneal examination findings and changes in best-corrected visual acuity. Treatment decisions, including dose modifications, should be based on the most severe finding present. These guidelines are recommended for the assessment and management of belamaf-associated ocular events to help mitigate ocular risk and enable patients to continue to experience a clinical benefit with belamaf.