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Background: Pregnancy results in various changes to all systems within the body, including the visual system. During pregnancy, several physiological changes can occur within the eye, such as changes to the corneal morphology, dry-eye disease, and a reduction in intraocular pressure. Pathological ocular conditions may also occur during pregnancy due to a pre-existing disease or a new disease. Aim and Objective: The aim of the study is to examine ocular changes in pregnancy in north India. Materials and Methods: A prospective cross-sectional clinical study was done in 100 women with pregnancy (gestational period from 24 weeks to 38 weeks). A detailed medical, ocular, and gestational history was obtained. All pregnant women underwent a detailed eye examination, including assessments of visual acuity, refraction, ocular motility, keratometric reading, anterior segment examination with a slit lamp biomicroscope, intraocular pressure recording with a non-contact tonometer, corneal sensitivity, and dilated fundus examination. Results: A total of 100 women with pregnancy (gestational period 24-38 weeks) underwent detailed eye examinations. 40% showed clinically significant retinal changes with high blood pressure, and in these cases, only 30% showed physiological changes along the way. Conclusions: All pregnant women during the antenatal and postpartum periods should undergo a complete ophthalmic examination and treatment. Early detection of retinal abnormalities can prevent serious complications. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of ultrasound cycloplasty in eyes with primary or secondary open-angle glaucoma, not amenable to adequate control of intra-ocular pressure (IOP) with medical treatment.Methods: Prospective interventional cohort study of 28 eyes of 28 subjects in a tertiary eye care centre in India in patients with open-angle glaucoma. All enrolled eyes underwent ultrasound cycloplasty with the second-generation probe with six shots of 8 s each, operated by a single surgeon between November 2018 and January 2020. They were followed up for a period of 12 months. The primary treatment outcome was IOP and the secondary outcomes were vision and postoperative complications.Results: A total of 28 eyes of 28 patients were studied, and the mean age was 63.82 ± 6.46 years. Primary open-angle glaucoma (75%) was the most common etiology. There was significant reduction in IOP from the baseline (24.93 ± 4.27 mmHg) to the postoperative value (15.82 ± 3.14 mmHg) at the end of 12 months (P < 0.00001). Mean reduction in IOP was 9.14 ± 4.09 mmHg at 12 months (36.66%). Number of ocular hypotensives reduced significantly from baseline (3.32 ± 0.47) to 12-month postoperative follow-up (0.68 ± 0.74) (P < 0.00001). Qualified success was achieved in 89.28% eyes. No major complications were noted.Conclusion: Ultrasound cycloplasty is found to be effective and safe in eyes with open-angle glaucoma because of the primary or secondary etiology, being more effective in the former. [ABSTRACT FROM AUTHOR]

Purpose: To determine the proportion of erroneously assumed ocular hypertension (OHT) among referred patients of elevated intraocular pressure (IOP) seen in glaucoma clinic of a teaching hospital in Northern India.Methods: Retrospective review of case records of referred, diagnosed patients of OHT or unspecified glaucoma seen between January 2019 and March 2020. Using an algorithmic clinical approach, including gonioscopy, Goldmann applanation tonometry (GAT), and pachymetry, underlying cause for elevated-IOP was amended and proportion of erroneously assumed OHT was calculated.Results: Of 276 patients diagnosed either as OHT or unspecified glaucoma before being seen at our glaucoma clinic, 44 (16%) had IOP within normal range (10-21 mmHg) on GAT. In 97 (35%) cases elevated-IOP was associated with angle closure. The central corneal thickness (CCT) was >550 μm in 39 (14%) patients with elevated-IOP. The proportion of erroneously assumed OHT was 70% in this study.Conclusion: The elevated-IOP does not imply with OHT unless evident through comprehensive clinical examination and appropriate investigations. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to study the perception of residency trainers about an optimum residency program.Methods: A survey, using a pre-validated questionnaire, was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2019-20 with questions directed to teachers in medical colleges and national board of examination's ophthalmology residency programs on demography, teaching experience, imparting clinical and surgical skills, ideal academic schedule and dissertation in the post-graduate residency program.Results: The response rate in the survey was 47.6%. Valid responses were obtained from 309 residency trainers. Of these, 132 of 309 (42.7%) were females. The mean age was 45.3 ± 9.5 years, range 26-68 years. The trainers believed that on a scale of 0-10, clinical skills teaching should be taught, mean ± SD: slit lamp 9.8 ± 0.7; indirect ophthalmoscopy 9.3 ± 1.3; gonioscopy 9.2 ± 1.5; perimetry 8.9 ± 1.5; OCT 8.4 ± 1.9; applanation tonometry 9.5 ± 1.2 and orthoptic evaluation 8.1 (±1.9). A resident should ideally perform independently surgeries (median, inter-quartile range IQR): SICS 50 (IQR 40-100); phaco 50 (20-60); pterygium excision 20 (10-40); DCR 10 (5-20); chalazion 20 (10-50), trabeculectomy 7 (5-15); strabismus 5 (2-10), LASIK and retinal detachment 0. Ideally there should be four lectures, four seminars, four case presentations, five journal clubs and four wet labs every month.Conclusion: Teachers expected their wards to become competent professionals. There was near unanimity about the content of clinical skills training, non-medical skills and academics, but there was a significant variation on extent of surgical training that should be imparted to the residents. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence and risk factors of Uncorrected Refractive Errors (URE) for distance in elderly residents in 'homes for the aged' in Hyderabad, India. Methods: Individuals aged ≥60 years and residing in 'homes for the aged' in Hyderabad, India for a minimum of 1 month and providing consent for participation were recruited. All participants underwent visual acuity assessment, refraction, slit lamp biomicroscopy, intraocular pressure measurement, fundus examination, and retinal imaging. Monocular presenting visual acuity was recorded using a logMAR chart. Objective and subjective refraction were performed, and best‐corrected visual acuity was recorded. URE was defined as presenting visual acuity worse than 6/12 but improving to 6/12 or better with refraction. Univariable and multivariable logistic regression analyses were used to assess the risk factors associated with URE. Results: In total, 1 513 elderly participants were enumerated from 41 homes of which 1 182 participants (78.1%) were examined. The mean age of participants was 75.0 years (standard deviation 8.8 years; range: 60–108 years). 35.4% of those examined were men and 20.3% had no formal education. The prevalence of URE was 13.5% (95% CI: 11.5–15.5; n = 159). On applying multiple logistic regression analysis, compared to those living in private homes, the odds of URE were significantly higher among the elderly living in the aided homes (OR: 1.65; 95% CI: 1.11–2.43) and free homes (OR: 1.67; 95% CI: 1.00–2.80). As compared to those who reported having an eye examination in the last 3 years, the odds of URE were higher among those who never had an eye examination in the last three years (OR: 1.51; 95% CI: 1.07–2.14). Similarly, those who had unilateral cataract surgery (OR: 1.80; 95% CI: 1.10–2.93) or bilateral cataract surgery (1.69; 95% CI: 1.10–2.56) had higher odds of URE compared to those elderly who were not operated for cataract. Gender, self‐report of diabetes, and education were not associated with URE. Conclusions: A large burden of URE was found among the residents in the 'homes for the aged' in Hyderabad, India which could be addressed with a pair of glasses. Over 40% of the residents never had an eye examination in the last three years, which indicates poor utilisation of eye care services by the elderly. Regular eye examinations and provision of spectacles are needed to address needless URE for distance among the elderly in residential care in India. [ABSTRACT FROM AUTHOR]

Introduction: At present, refractive accuracy is the demand of cataract surgery which can be achieved by providing precise post-operative vision without spectacles. One of the important factors required to give spectacle free vision is calculation of accurate biometry. In developing countries like India, Small Incision Cataract Surgery (SICS) is done more commonly than phacoemulsification with foldable Intraocular Lenses (IOLs). Aim: To evaluate the accuracy of Immersion A-scan and Optical biometry in patients undergoing SICS with foldable IOLs by assessing their one month post-operative refraction and converting these values in predicted emmetropic IOL powers. Materials and Methods: Prospective study was conducted on 60 patients to be posted for cataract extraction in Department of Ophthalmology, Bharati Medical College and Hospital (Deemed to be university), Sangli, Maharashtra, India, for two months from the period of January 1, 2019 to March 1, 2019. Preoperatively patients were randomly divided in two groups containing 30 patients each, Group A was subjected to Immersion A-scan and Group B to Optical biometry. Patients included in the study preoperatively also underwent Best Corrected Visual Acuity (BCVA) estimation, applanation tonometry, slit lamp examination of anterior and posterior segment and Keratometry. Patients were examined post-operatively on 1st, 7th, and 30th day, for slit lamp examination of anterior and posterior segments and also their BCVA was noted. Final refraction was given on 30th postoperative day based on their auto-refractometer readings. Postoperative refraction and actual IOL power placed was used to calculate IOL power that would have produced emmetropia in that particular patient by the help of regression formula. Difference in actual IOL power placed and predicted emmetropic IOL power was also noted in each patient of both groups. Unpaired t-test was used for the statistical analysis. Results: The mean Axial Length (AXL) measured by immersion A-scan in group A was lesser (22.91 mm) than that with IOL master (23.15 mm) with a mean difference of 0.24 mm (p=0.133). Mean actual post-operative refraction at one month in group A was higher (0.90) than that of group B (0.70) with a mean difference of 0.20 (p=0.166). Mean difference between actual IOL (aIOL) placed and predicted emmetropic IOL (eIOL) was higher in group A (1.35) than that of group B (0.96) with a mean difference of both group was 0.39 (p=0.021). Conclusion: In the range of AXL 22 mm to 24.50 mm, used in this study, there is no statistically significant difference in axial length measurements between two methods of Ultrasound biometry and Optical biometry. Patients in Group A of present study had significant post-operative residual refraction as compared to Group B patients, which can be attributed to inaccurate Keratometry as two different methods of Keratometry were done in two groups. Keratometry values can influence post-operative refraction and inaccurate Keratometry may land with post-operative refractive errors. Current study showed certain advantages of optical biometry over USG biometry in that Optical biometry is Non-contact, fast and accurate, but optical biometry cannot be done in mature cataracts and dense posterior subcapsular cataract where immersion USG biometry is required. [ABSTRACT FROM AUTHOR]

Obstructive Sleep Apnoea (OSA) affects 2-5% of the middle-aged population and is a potentially life-threatening condition. Previous studies on OSA and glaucoma have reported mixed findings. This was a cross-sectional comparative study with a study duration of one year to compare the incidence of high intraocular pressure among OSA subjects and non-OSA subjects. This study took place in a tertiary hospital where a total of 50 subjects with OSA and 50 non-OSA subjects were recruited. The average age was 37 years (19,65) in a multiethnic study population (76% (Malay), 18% (Chinese) and 6% (Indian)). All patients underwent a full night computer-assisted polysomnogram (SOMNOCheck Effort Weinmann, Hamburg, Germany), Epworth Sleepiness Scale (ESS), Mullers manouevre (MM) to assess the level of obstruction and tonometry. The incidence of high Intra Ocular Pressure (IOP) among OSA subject was 52% with a significant difference between non-OSA and OSA subjects. Correlation between ESS and IOP were significant (p<0.05) for both eyes. There was a significant difference in mean IOP between non-OSA and OSA subjects for both eyes (p<0.05). A significant association was found between the presence of collapse at retropalatal and retrolingual region with high IOP (p<0.05). The incidence of high IOP among OSA patient (52%) provides a new insight in the management of patients with OSA. Significant associations exist between OSA parameters (ESS and presence of collapse on Mullers manouevre) and high IOP. We strongly recommend periodic ophthalmic assessment of intraocular pressure in patients with OSA. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to assess the efficacy of ultrasound cycloplasty (UCP) in Indian patients with open angle glaucoma (OAG).Methods: A prospective interventional study was designed to treat 73 eyes of 73 patients with OAG with the EyeOP1 device equipped with six miniaturized cylindrical piezoelectric transducers. Two treatment protocols of ultrasound delivery depending on exposure time (8 s and 10 s of shot per transducer) were used. Complete ophthalmic examination, ocular biometry and anterior segment optical coherence tomography were performed preoperatively and patients were followed up at day 1, day 7 and months 1, 2, 3, 6, and 12. The primary outcome measure was "successful" intraocular pressure (IOP) control defined as IOP reduction ≥20% from baseline and IOP value >5 mm Hg at the last follow-up visit. Secondary outcomes were the occurrence of complications and mean IOP during the follow-up period.Results: In all patients, the mean IOP reduced from 23.5 ± 3.0 mmHg before treatment to 15.7 ± 5.4 mmHg at 12 months (P < 0.05). Successful IOP control after a single procedure was 78.3% (79% and 78% in the 8 s and 10 s groups, respectively) at 12 months. Overall, the mean IOP reduction achieved in responding patients was 41% (standard deviation = 12%). Notwithstanding minor side effects such as transient pain, anterior chamber reaction, and refractive error changes, no major intraoperative or postoperative complications (severe hypotony or phthisis) were observed during the follow-up.Conclusion: Our short-term results reveal that UCP is a simple, safe, and noninvasive procedure which enables to significantly reduce the IOP in patients with OAG. The study results in Indian eyes corroborate findings in earlier studies on Caucasian eyes. [ABSTRACT FROM AUTHOR]

Background: To compare intraocular pressure (IOP) measurements obtained with the Topcon CT-80 non-contact tonometer (NCT) and Goldmann applanation tonometer (GAT), in different ranges of IOP in normal and glaucoma subjects, and to assess the influence of central corneal thickness (CCT) on the IOP measurements in Asian Indian eyes.Methods: Four hundred and two eyes of 402 subjects (193 newly diagnosed primary open angle glaucoma [POAG] and 209 normal) were enrolled for this prospective study. For each eye, IOP was measured with GAT by a glaucoma specialist and NCT by a trained optometrist. The IOP values were compared among the tonometers in the three different IOP ranges (≤ 12 mmHg, 13-20 mmHg and ≥ 21 mmHg) using Bland-Altman graphs. Correlation between GAT and NCT was assessed by Pearson correlation co-efficient. CCT was measured with ultrasound pachymetry and its correlation with GAT and NCT was analysed using linear regression analysis.Results: The mean paired difference of IOP between NCT and GAT was 1.556 ± 2.69 mmHg (r = 0.26, p = 0.006) at IOP range of ≤ 12 mmHg, -1.665 ± 2.6 mmHg (r = 0.51, p < 0.0001) in IOP range of 13-20 mmHg and -2.202 ± 3.44 mmHg (r = 0.82, p < 0.0001) in the IOP range of ≥ 21 mmHg. Linear regression analysis showed a mean IOP variation of 0.27 mmHg per 10 μm change in CCT for NCT (p < 0.0001) and IOP change of 0.19 mmHg per 10 μm change in CCT for GAT (p = 0.01).Conclusion: In this study of normotensive and POAG subjects, the Topcon CT-80 NCT showed an overestimation of IOP at the lower range and underestimation of IOP in normal and higher ranges of IOP. Clinicians should keep in mind that CCT influences IOP measurement with both types of tonometer and that the IOP readings obtained with these tonometers are not interchangeable. [ABSTRACT FROM AUTHOR]

Objective The present population-based study was undertaken to estimate the prevalence, determinants and causes of corneal morbidity and blindness in a rural North Indian population. Design Population-based study in India with 12 899 participants of all ages. Methods Participants were recruited from 25 village clusters of district Gurgaon, Haryana, India using random cluster sampling strategy. All individuals were examined in detail with a portable slit lamp for evidence of any corneal disease during the door-to-door examination. Comprehensive ocular examination including logMar visual acuity, slit lamp biomicroscopy, non-contact tonometry and dilated retinal evaluation was performed at a central clinic site in the respective villages. Results Overall, 12 113 of 12 899 people (93.9% response rate) were examined during the household visits. Prevalence of corneal disease was 3.7% (95% CI 3.4% to 4.1%) and that of corneal blindness was 0.12% (95% CI 0.05% to 0.17%). Multivariable analysis demonstrated that corneal disease was significantly higher in the elderly (p<0.0001) and illiterates (p<0.0001). Common causes of corneal opacity in the study population were pterygium (34.5%), ocular trauma (22.3%) and infectious keratitis (14.9%). Corneal diseases contributing to blindness were postsurgical bullous keratopathy (46.2%) and corneal degenerations (23.1%). Conclusions The study findings demonstrate that currently ocular trauma, infectious keratitis, post-surgical bullous keratopathy, and corneal degenerations are responsible for the major burden of corneal blindness and morbidity in the Indian population. The prevalence of corneal morbidity due to vitamin A deficiency and trachoma was low in this rural population. [ABSTRACT FROM AUTHOR]

Background: Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method, eye care professionals, use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Intraocular pressure usually increases with age and is genetically influenced. Aims & Objective: To study the variation of IOP with age and gender. Materials and Methods: A case control study was conducted in 50 Male and 50 Female subjects above the age of 40 years with normotension, without any glaucoma and raised IOP. Statistical analysis was done by using student "t" test and ANOVA. Results: There is statistically significant difference between the mean IOP in males and IOP in females (P < 0.05). There is significant positive correlation between age and IOP (r =0.911). Conclusion: Mean intraocular pressure increases with increasing age group with higher values seen in females. It would be more accurate if ophthalmologists acquire the habit of approximating measured IOP to the nearest one mmHg and not to the nearest even number. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the distribution of central corneal thickness (CCT) and its associations in an adult Indian population. Design: Population-based study. Participants: The Central India Eye and Medical Study is a population-based study performed in a rural region close to Nagpur in Central India; it included 4711 subjects (ages 30+ years) of 5885 eligible subjects (response rate, 80.1%). Methods: The participants underwent a detailed ophthalmic and medical examination, including 200 standardized questions on socioeconomic background, lifestyle, social relations, and psychiatric depression. This study was focused on CCT as measured by sonography and its associations. Intraocular pressure was measured by applanation tonometry. Main Outcome Measures: Central corneal thickness and intraocular pressure. Results: Central corneal thickness measurement data were available on 9370 (99.4%) eyes. Mean CCT was 514±33 μm (median, 517 μm; range, 290–696 μm). By multiple regression analysis, CCT was associated significantly with younger age (P<0.001), male gender (P<0.001), higher body mass index (P = 0.006), lower corneal refractive power (P<0.001), deeper anterior chamber (P = 0.02), thicker lens (P = 0.02), and shorter axial length (P = 0.006). Central corneal thickness was not associated significantly with refractive error (P = 0.54) or cylindrical refractive error (P = 0.20). If eyes with a corneal refractive power of 45 or more diopters were excluded, the relationship between CCT and axial length was no longer statistically significant (P>0.05), whereas all other relationships remained significant. Intraocular pressure readings increased significantly (P<0.001) with both higher CCT and higher corneal refractive power. Conclusions: Indians from rural Central India have markedly thinner corneas than do Caucasians or Chinese, and, as in other populations, CCT is greater in men. CCT was associated with younger age, higher body mass index, lower corneal refractive power, deeper anterior chamber, thicker lens, and shorter axial length. Intraocular pressure readings were associated with CCT, with high readings in those eyes that had thick corneas or steep corneas. Central corneal thickness and steepness of the anterior corneal surface may thus both have to be taken into account when applanation tonometry is performed. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Objective: To evaluate the characteristics of central corneal thickness (CCT) and its association with age, gender, and intraocular pressure in rural and urban South Indian populations. Design: Population-based cross-sectional study. Participants: Seven thousand seven hundred seventy-four subjects (rural-to-urban ratio, 3924:3850) aged 40 years and older were examined at a dedicated facility in the base hospital. Intervention: All subjects underwent a complete ophthalmic examination that included CCT measurements with an ultrasonic pachymeter and applanation tonometry. Main Outcome Measures: Central corneal thickness. Results: Of the 7774 subjects examined, 974 had undergone cataract surgery and were excluded. The remaining 6800 were bilaterally phakic, of which 46 were excluded (17 glaucoma subjects receiving treatment, 12 with corneal pathologic features and 17 with incomplete data) and 6754 subjects data were analyzed. The mean CCT for the population was 511.4±33.5 μm, and CCT in males (515.6±33.8 μm) was significantly (P = 0.0001) greater than females (508.0±32.8 μm). The CCT was significantly greater (by 18 μm) in the urban population and decreased with age in both genders (P<0.0001). The decrease per decade was 4.34 μm (95% confidence interval [CI], 3.24–5.44) in the rural population and 2.41 μm (95% CI, 1.25–3.53) in the urban population. A 100-μm increase in CCT was associated with a 1.96-mmHg increase in intraocular pressure in the rural population, versus 2.45 mmHg for every 100 μm in the urban population. Conclusions: In this population-based study, females and subjects living in a rural area had thinner corneas. A negative association with age and a positive association with intraocular pressure were seen. These findings will have implications in the diagnosis and management of glaucoma in this population. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Glaucoma is the second leading cause of blindness in India. Despite advances in diagnosing and managing glaucoma, there is a lack of India-specific clinical guidelines on glaucoma. Ophthalmologists often refer to the European Glaucoma Society (EGS) and Asia-Pacific Glaucoma Society (APGS) guidelines. A group of glaucoma experts was convened to review the recently released EGS guideline (fifth edition) and the APGS guideline and explore their relevance to the Indian context. This review provides the salient features of EGS and APGS guidelines and their utility in Indian scenario. Glaucoma diagnosis should be based on visual acuity and refractive errors, slit-lamp examination, gonioscopy, tonometry, visual field (VF) testing, and clinical assessment of optic nerve head, retinal nerve fiber layer (RNFL), and macula. The intraocular pressure target must be individualized to the eye and revised at every visit. Prostaglandin analogues are the most effective medications and are recommended as the first choice in open-angle glaucoma (OAG). In patients with cataract and primary angle-closure glaucoma (PACG), phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Trabeculectomy augmented with antifibrotic agents is recommended as the initial surgical treatment for OAG. Laser peripheral iridotomy and surgery in combination with medical treatment should be considered in high-risk individuals aged <50 years. In patients with phakic and PACG, phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Visual acuity, VF testing, clinical assessment of the optic disc and RNFL, and tonometry are strongly recommended for monitoring glaucoma progression., Competing Interests: None