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Abstract: Background: In high altitude areas, patients report with irritation, redness and foreign body sensation in their eyes suggesting tear film abnormality due to low humidity and windy environmental conditions. Methods: Tear Break- up Time (TBUT) was studied in 100 subjects consisting of local population and those originally from plains residing in high altitude areas in Ladakh. Result: There were 24% individuals with TBUT of < 5 seconds, 30% between 6–10 seconds and 46% with TBUT of>10 seconds. In symptomatic patients with TBUT of <5 seconds, eight cases had irritation of eyes, six foreign body sensation and two cases had pain, watering, irritation and redness of eyes. Pterygium was seen in 12 individuals and inter palpebral congestion in 4 cases. Conclusion: A total of 24% cases showed abnormal (<5 seconds) TBUT. Abnormality of tear film in the presence of low humidity and windy condition with high ultraviolet radiation may lead to ocular discomfort and pterygium in these areas. [Copyright &y& Elsevier]

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

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

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

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

Introduction: Dry eye (keratoconjunctivitis sicca) is a common disorder of the tear film having multifactorial aetiology. Nowa- days, a large portion of population is affected with Dry Eye Disease (DED) because of substantial increase in usage of computers and digital devices. Aim: To evaluate the effect of varying durations of computer usage on parameters of DED. Materials and Methods: In this prospective study, total 120 participants were divided into two groups. Group I (n=58) included participants who used computer daily for less than six hours while group II (n=62) included those who used computer for more than six hours daily. Routine eye examination was done and dry eye parameters i.e., Ocular Surface Diseases Index (OSDI), Schirmer Test (ST) and Tear Film Break Up Time (TFBUT) were performed and analysed for any significant difference between groups I and II using unpaired t-test. SPSS 16.0 was used and p-value <0.05 was considered as statistically significant. Pearson's correlation test was performed to analyse correlation of OSDI score with TFBUT and ST values. Results: Mean OSDI scores in group I and group II were 37.39±8.98 and 49.54±11.7 (p<0.001), respectively; while TFBUT values were 10.19±2.27 seconds and 8.12±2.9 seconds (p<0.001), respectively. ST values were 12.82±3.32 mm in group I and 10.80±3.86 mm in group II (p=0.0027). Significant inverse correlation between OSDI score and TFBUT values was found in both group I (r=-0.557, p<0.001) and group II (r=-0.439, p<0.001). Similarly, correlation of OSDI score with ST values in group I (r=-0.787, p<0.001) and group II (r=-0.320, p=0.011) was also inversely significant. On the basis of OSDI score, 38 (65.5%) participants in group I and 54 (87.08%) participants in group II had severe dry eye. According to TFBUT values 12 (20.68%) participants in group I and 29 (46.77%) participants in group II and as per ST values 17 (29.31%) participants in group I and 30 (48.38%) participants in group II had severe dry eye. Conclusion: Usage of computer or digital displays more than six hours per day is a potential cause for the development of severe DED. [ABSTRACT FROM AUTHOR]

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

Purpose: To study the effect of exposure to high level of air pollution on ocular surface health. Materials and Methods: A total of 520 subjects volunteered to participate in this study. All volunteers were required to give a detailed history and were subjected to ophthalmic examination under slit lamp, visual acuity test, tear fi lm break-up time (BUT) and Schrimer's test. Results: Significantly high number of subjects in study group complained of ophthalmic symptoms compared to control group. Sevent eight per cent subjects in the study group had symptoms such as redness, watering, irritation, strain or photophobia whereas this number was 45% in control group. Schirmer's test showed a significantly low value of 22.75±8.91 mm in study group as compared to 30.30±7.92 mm in control group (P<0.001). Average tear break-up time in study group was significantly low (P<0.05) with a value of 11.17±2.92 seconds compared to 12.13 ± 3.24 seconds in control group. Conclusion: Results of our study indicate that people traveling in highly polluted areas and exposed to high level of air pollutants are likely to suffer from significantly high incidence of subclinical ocular surface disorders. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to describe the clinical characteristics and risk factors of short tear film break-up time (TBUT) type of dry eye disease and compare it with other types of dry eye diseases.Methods: This cross-sectional study included 570 patients (≥ 20 years) from the outpatient department using systematic random sampling.Results: The age-adjusted prevalence of short TBUT type of dry eye disease was 5.4% (95% confidence interval: 3.2-6.8%). There was no difference (P > 0.05) between the total and subscale scores of the Ocular Surface Disease Index® questionnaire between patients with short TBUT and those with aqueous tear deficiency. Both these groups differed significantly (P < 0.05) in the findings of TBUT, Schirmer I test, and Lissamine green staining score. The common symptoms in patients with short TBUT type of dry eye disease were eye fatigue (25.4%), heaviness in the eye (19.7%), and an uncomfortable sensation (14.1%). The symptoms in the aqueous tear deficiency group were light sensitivity (28.2%), dryness (19.2%), burning (13.0%), foreign body sensation (12.8%), and blurring of vision (14.1%). The risk factors associated with short TBUT type of dry eye disease were the presence of meibomian gland dysfunction (odds ratio: 3.759 [95% confidence interval: 2.135-6.618], P < 0.0001) and female sex [odds ratio: 1.954 (95% confidence interval: 1.042-3.667), P = 0.037].Conclusion: Patients with short TBUT type of dry eye disease have symptom severity similar to aqueous tear-deficient dry eyes, but the pattern is different. The finding of this type of dry eye disease in India indicates its global presence, and ophthalmologists should consider it in their differential diagnoses. [ABSTRACT FROM AUTHOR]

Introduction: Dry eye is a multifactorial condition of the eye caused by insufficient tear production and imbalance in tear composition leading to faster evaporation of tear fluid. It is also associated with inflammation that often leads to ocular surface damage. Symptoms of dry eyes include itchiness, soreness, red eyes, a burning sensation, eye fatigue and blurred vision. The objective of this study was to evaluate the efficacy and safety of our multi-ingredient supplement in subjects with dry eye syndrome (DES). Methods: We recruited 60 subjects with mild to moderate DES who were randomized in a 1:1 ratio in a single-center study to receive LCD (lutein 20 mg, zeaxanthin 4 mg, curcumin 200 mg curcuminoids, vitamin D3 600 IU) or placebo (soybean oil) capsules for 8 weeks. The primary outcomes evaluated were changes in tear volume by Schirmer's test and ocular symptoms by the Ocular Surface Disease Index (OSDI); secondary outcomes included evaluation of changes in Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear film break-up time (TBUT), corneal and conjunctival staining, tear osmolarity, matrix metalloproteinase-9 (MMP-9), artificial tear use and safety assessments. The outcomes were compared between the LCD and placebo groups at baseline and day 56 of supplementation. Results: Fifty-nine subjects, 30 from LCD and 29 from placebo group, completed the study. The LCD group showed significant improvements (P < 0.0001) for Schirmer's test, OSDI, TBUT, SPEED, ocular staining scores, tear osmolarity (P = 0.0005), MMP-9 (P = 0.0017) and reduced artificial tear use (P = 0.0004) and its frequency of use (P < 0.0001) in subjects compared to placebo from baseline to day 56. No safety issues were observed in the study. Conclusion: The LCD supplement showed significant improvements in the production, stability and quality of tears by reducing ocular surface damage and tear inflammation and can be used as an adjuvant to artificial tears in subjects with DES. Trial Registration: Clinical Trials Registry of India (http://ctri.nic.in/) identifier: CTRI/2021/01/030493. [ABSTRACT FROM AUTHOR]

Purpose: Ophthalmic complications in diabetes such as retinopathy, cataract, and infections have been extensively studied. Recently, attention has been drawn toward ocular surface changes in diabetes mellitus (DM). This study has been carried out to investigate the tear film and ocular surface abnormalities in type II DM patients.Materials and Methods: A total of 83 participants (130 eyes) were enrolled: 53 diabetics (80 eyes) and 30 healthy controls (50 eyes). Of the 53 diabetics, 24 patients (42 eyes) had some diabetic retinopathy. The tear film and ocular surface were evaluated using Schirmer test, tear film break-up time (TBUT), keratoepitheliopathy score (KES), Rose Bengal Staining (RBS) test, and conjunctival impression cytology.Results: When compared with the healthy controls, diabetics showed significantly reduced Schirmer, TBUT measurements and the higher grades of KES and RBS test (P < 0.001). Impression cytology analysis showed goblet cell loss and conjunctival squamous metaplasia in diabetics.Conclusion: Tear film abnormality is a significant feature of diabetic ocular surface diseases. These abnormalities are likely on account of poor quality and function of tears, combined with the subnormal ocular surface. Therefore, all diabetic patients especially those with evidence of retinopathy changes should undergo routine early examination and follow-up of tear function and ocular surface parameters. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to study the prevalence of DED and analyze risk factors in North Indian population.Methods: This was a cross-section hospital-based, observational study. Cases enrolled over 2 years (systematic random sampling) were administered ocular surface disease index questionnaire to evaluate the prevalence and risk factors of DED. Schirmer's test and tear break-up time were performed only in the subset of patients giving consent. Categorical data were assessed with Chi-square/Fisher's Exact test, and odds ratio was analyzed using bivariate and multivariate logistic regression. P < 0.05 was statistically significant.Results: A total of 15,625 patients were screened. The prevalence of DED was 32% (5000/15625); 9.9% (496/5000) had mild DED; 61.2% (3060/5000) had moderate DED; and 28.9% (1444/5000) had severe DED. Age group of 21-40 years, male sex, urban region, and desk job were associated with increased risk of DED. Hours of visual display terminal (VDT) usage significantly correlated with DED (P < 0.001), and 89.98% of patients with 4 h or more of VDT use had severe dry eye. Cigarette smoking and contact lens usage had increased odds of developing severe DED (P < 0.001). Objective tests were undertaken in 552 patients; of these, 81.3% (449/552) had severe DED.Conclusions: The prevalence of DED in North India is 32%, with the age group of 21-40 years affected most commonly. VDT use, smoking, and contact lens use were associated with increased odds of developing DED. [ABSTRACT FROM AUTHOR]

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

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

Background: Studies have indicated 54% prevalence of asymptomatic and symptomatic DES, in diabetes. However, the relationship between diabetes and DES still remains unclear. The reported prevalence of DES in diabetics is 15-33% in those over 65 years of age and increases with age and is 50% more common in women than in men. Aim of the study: To evaluate the prevalence, etiology and clinical manifestations of dry eye syndrome in patients with diabetes mellitus. Materials and methods: The present study was conducted in the Department of Ophthalmology. We selected 100 diabetic patients who reported to the outpatient department with type 2 diabetes mellitus. Clinical data of all patients which included sex, age, duration of diabetes as well as a history of other diseases, were obtained by reviewing the medical records and direct patient interview. Subjects with secondary diabetes and those who on medication or have other diseases were excluded. Dry eyes were suspected on the basis of a history of ocular discomfort, including soreness, gritty sensation, itchiness, redness, blurred vision that improves with blinking and excessive tearing. Results: A total of 100 patients were included in the study. The mean age of the patients was 59.21 years. The mean HbA1c level in the patients was at 7.81. Out of the total 100 patients, 39 patients were diagnosed with dry eye. The variables between both the groups were comparable and were statistically non-significant. Conclusion: From the results of present study, this can be concluded that with the available common diagnostic tests for evaluation of dry eye syndrome, the prevalence of dry eye syndrome in diabetic patients is underestimated. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Purpose: Smoking is a global health problem with a high burden of smokers in India and the world as well. Smoking is a known eye irritant that may have a significant effect on the anterior ocular surface. Hence, the present study was aimed to investigate the effect of smoking on dry eye parameters, ocular surface, and central corneal thickness (CCT) and to compare the results with nonsmokers.Methods: In this cross-sectional study, 40 (80 eyes) smokers and 40 (80 eyes) age-matched nonsmokers were included. The severity of ocular surface disease symptoms was assessed by the Ocular Surface Disease Index (OSDI) tool. All participants underwent a series of measurements, that is, the Schirmer's II test score and tear breakup time (TBUT). Tear meniscus height (TMH) and CCT were measured using anterior segment optical coherence tomography (OCT).Results: The mean value of all dry eye parameters was statistically different among the group of smokers and nonsmokers. The mean score of symptomatic assessment (OSDI) was observed to be significantly higher in smokers than in nonsmokers (P < 0.0001), and dry eye parameters, that is, Schirmer's score (P = 0.0127), TMH (P < 0.0001), and TBUT (P < 0.0001) were significantly lower among smokers than nonsmokers. There was no significant difference in CCT between smokers and nonsmokers (P = 0.06).Conclusion: Cigarette smoking has deteriorating effects on the ocular surface. Exposure to smoking was found to be associated with dryness of the eye. Further studies are needed on a molecular basis. [ABSTRACT FROM AUTHOR]

Objectives: The use of benzalkonium chloride (BAC)-preserved medications is associated with ocular surface disease (OSD) that can negatively affect quality of life (QoL) in glaucoma patients. This study aimed to compare QoL and correlate it with OSD in glaucoma patients receiving BAC-preserved and BAC-free travoprost. Materials and Methods: A total of 110 subjects were divided into 3 groups: 40 primary open-angle glaucoma (POAG) patients using BAC-preserved travoprost, 40 POAG patients using BAC-free travoprost, and 30 age-matched controls. All patients were assessed using a single interviewer-administered format of the Ocular Surface Disease index (OSDI) and Glaucoma Quality of Life-15 (GQL-15) questionnaires. Results: Mean GQL-15 score in the BAC group was significantly higher than in the BAC-free group (24.71±7.42 vs. 17.58±3.06; p<0.05). The mean difference in GQL-15 scores between controls and the BAC-free group (1.24) was insignificant (p>0.05). There was a strong positive correlation between OSDI scores and GQL-15 scores in all the groups (r values: BAC: 0.63, BAC-free: 0.23, controls: 0.29), with higher OSDI scores (severe OSD) associated with higher GQL-15 scores (worse QoL). Cronbach's alpha was 0.84 for GQL- 15 and 0.75 for OSDI. Conclusion: BAC-preserved travoprost leads to higher OSDI scores, which correlate strongly with poor QoL scores as compared to BAC-free travoprost. The use of BAC-free formulations should be encouraged to reduce the onset or worsening of OSD and impaired QoL in glaucoma patients. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is a chronic immune-mediated disorder with predominantly dermatological manifestations and varying prevalence in different parts of the world. Data on the ocular features of this disease are limited. Hence, we aimed to estimate the burden of ocular disease in psoriatic patients in the Indian population. Materials and methods: An interdisciplinary cross-sectional hospital-based observational study was conducted in South India, wherein an ophthalmological evaluation was performed for the patients with Psoriasis. The ocular features were recorded and compared with the severity of psoriasis using the Psoriasis Area Severity Index (PASI) score. Results: Ocular morbidity was observed in 80% of the patients with psoriasis which increased with increasing duration (p = 0.004) and increasing PASI score (p < 0.001). Blepharitis and dry eye disease were common in our patients with psoriasis. Conclusion: It is important to screen patients with psoriasis for ocular comorbidities so as to prevent sight-threatening complications. [ABSTRACT FROM AUTHOR]

Background: Developing countries at tertiary referral centre. The aim of this study was to share our experience of paediatric achalasia in Indian scenario. Materials and Methods: This was a retrospective analysis of children <16 years, operated for achalasia at our centre, from December 1998 to December 2011. Results: Total 40 patients (mean age 39 ± 4.29 months), including 1 patient of megaesophagus were operated over 13 years of period; 17 patients (associated congenital H-type tracheoesophageal fistula in one patient, non- responders/ lost follow-up for minimum of 3 years in 16 patients) were excluded from the study. The response rate of parents in followup was 60.0%. Mean symptoms duration was 27.88 ± 2 months. Most common symptoms were regurgitation and failure to thrive (78.2%). Mean symptom scoring in follow-up after 3 year was 1 ± 0.7 compared to 5 ± 0.51 at the time of admission (P < 0.012). One infant expired (mediastenitis), one developed adhesive intestinal obstruction and one needed posterior re-myotomy (for megaesophagus). There were no treatment failures in mean follow-up of 40.2 ± 5.07 months. Conclusions: Cardiomyotomy with partial fundoplication is the best modality of treatment for paediatric achalasia cardia, even from parents' perspective. [ABSTRACT FROM AUTHOR]

This section presents studies dealing with external eye and cornea. A study made on 42 patients at Aravind Eye Hospital in Madurai, India who were given topical moxifloxacin to treat culture confirmed bacterial keratitis is presented. Five hundred ninety eight Descemet stripping with endothetial keratoplasty (DSEK) procedures are studied for graft rejection. The rate of graft detachment decreased when donor grafts are presoaked in balanced salt solution (BSS) plus for Descemet's stripping with endothetial keratoplasty (DSEK).

Purpose: To study the knowledge, attitude and practices (KAP) towards computer vision syndrome prevalent in Indian ophthalmologists and to assess whether 'computer use by practitioners' had any bearing on the knowledge and practices in computer vision syndrome (CVS).Materials and Methods: A random KAP survey was carried out on 300 Indian ophthalmologists using a 34-point spot-questionnaire in January 2005.Results: All the doctors who responded were aware of CVS. The chief presenting symptoms were eyestrain (97.8%), headache (82.1%), tiredness and burning sensation (79.1%), watering (66.4%) and redness (61.2%). Ophthalmologists using computers reported that focusing from distance to near and vice versa (P =0.006, chi2 test), blurred vision at a distance (P =0.016, chi2 test) and blepharospasm (P =0.026, chi2 test) formed part of the syndrome. The main mode of treatment used was tear substitutes. Half of ophthalmologists (50.7%) were not prescribing any spectacles. They did not have any preference for any special type of glasses (68.7%) or spectral filters. Computer-users were more likely to prescribe sedatives/anxiolytics (P = 0.04, chi2 test), spectacles (P = 0.02, chi2 test) and conscious frequent blinking (P = 0.003, chi2 test) than the non-computer-users.Conclusions: All respondents were aware of CVS. Confusion regarding treatment guidelines was observed in both groups. Computer-using ophthalmologists were more informed of symptoms and diagnostic signs but were misinformed about treatment modalities. [ABSTRACT FROM AUTHOR]

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

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

Purpose: To estimate the prevalence and determine risk factors for dry eye disease (DED) in geographically diverse regions of India., Method: A population based cross-sectional study was conducted on people aged ≥40 years in plain, hilly and coastal areas. Dry eye assessment by objective [tear film break-up time (TBUT), Schirmer I, corneal staining] and subjective [Ocular Surface Disease Index (OSDI)] parameters was performed with questionnaire-based assessment of exposure to sunlight, cigarette smoke, indoor smoke. The prevalence of DED with age, sex, occupation, location, smoking, exposure to sunlight, indoor smoke, diabetes, hypertension, was subjected to logistic regression analysis., Results: 9,735 people (age 54.5 ± 0.1 years; range 40-99, males 45.5%) were included. The prevalence of DED was 26.2%, was higher in plains (41.3%) compared to hilly (24.0%) and coastal area (9.9%) (p < 0.001) and increased with age (p < 0.001), female gender (p < 0.001), smoking (p < 0.001), indoor smoke (p < 0.001), diabetes (p-0.02), hypertension (0.001), occupations with predominant outdoor activity (p-0.013) and increasing exposure to sunlight (trend). Multi-logistic regression showed a positive association with female sex (OR-1.2, CI-1.01, 1.4), exposure to indoor smoke (OR-1.3, CI-1.1, 1.5), smoking (OR-1.2; CI-1.03, 1.3), prolonged exposure to sunlight (OR-1.8, CI-1.5, 2.2), hypertension (OR 1.3, CI-1.2, 1.4), diabetes (OR-1.2, CI-1, 1.5) and negative association with region - hilly (OR-0.5, CI-0.4, 0.6) and coastal (OR-0.2; CI-0.1, 0.2), and BMI (OR-0.8, CI-0.7, 0.9)., Conclusion: DED is common in population ≥40 years of age. Its prevalence is affected by extrinsic (geographic location, exposure to sunlight, smoking, indoor smoke) and intrinsic (age, sex, hypertension, diabetes, BMI) factors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: To study the incidence of dry eye and its determinants in patients undergoing cataract surgery., Materials and Methods: One hundred twenty patients with senile cataract underwent Schirmer's test, tear break-up time (TBUT) test, lissamine green staining of the cornea and conjunctiva, and Ocular Surface Disease Index (OSDI) for evaluation of dry eye preoperatively and again at first and second follow-up examinations at 1 week and 1 month after cataract surgery., Results: Mean age of the patients was 59.25+9.77 years and 73 (60.8%) were men. None of the patients had dry eye at the time of enrollment as per the criteria of our study. Postoperatively, Schirmer's test values ranged from 12-35 mm and 8-24 mm at first and second follow-ups, respectively. Mean TBUT was 13.16±2.45 and 9.64±2.20 seconds, while lissamine green staining score was 3 in 67 (55.8%) and 1 in 67 (55.8%) subjects at first and second follow-up, respectively. OSDI values ranged from 1-30 and 10-33 with a mean of 25.97±5.34 and 11.96±7.47 respectively at first and second follow-up. At first follow-up, 89.1% of the 56 patients who underwent phacoemulsification were found to have grade 2 dry eye (p<0.001), while 92.2% of the 64 patients who underwent small-incision cataract surgery (SICS) had grade 2 dry eye (p<0.001). At second follow-up, grade 0 dry eye was observed in 92.2% of the patients who underwent phacoemulsification and 82.1% of the patients who underwent SICS (p<0.001)., Conclusion: The incidence of dry eye after cataract surgery was high and mostly independent of demographic and anthropometric profile, type of surgical procedure, time of microscope exposure, and amount of energy used. This dryness was transient in nature and showed a declining trend, tending to achieve normalization by the end of 1 month.

The aim of the study is to investigate the applicability of a newly developed corneal topographer in assessing tear film stability in Indian subjects. A prospective comparative study of 25 Indian subjects with dry eyes attending a tertiary eye care clinic in South India and 25 normal control subjects was conducted. The diagnosis of dry eye was made based on ocular surface disease index questionnaire. Non-invasive tear film break-up time (NI-TBUT) was measured using a new method based on a corneal topographer equipped with modified scan software. The correlations between the NI-TBUT and the traditional fluorescein tear film break-up time (F-TBUT), Schirmer I test values were determined. A total of 50 patients (100 eyes) were included. The values of NI-TBUT were significantly lower than the values of F-TBUT in both the cases (NI-TBUT 5.78 ± 0.8 s and F-TBUT 7.56 ± 0.5 s; p < 0.02) and controls (NI-TBUT 11.66 ± 1 s and F-TBUT 12.92 ± 1.2 s; p < 0.01). NI-TBUT values were significantly lower than the corresponding F-TBUT values in the varying grades of dry eyes. The mean NI-TBUT values in mild dry eyes was 6.42 ± 0.2 s, moderate dry eyes was 4.70 ± 0.3 s and in severe dry eyes was 2.32 ± 1.2 s. There was a significant difference in the NI-TBUT values for cases and controls (p < 0.001). There was a good correlation seen between the NI-TBUT values and the F-TBUT values, Schirmer I values and the ODSI scores. NI-TBUT was found to have a sensitivity of 86.1 % and a specificity of 81.1 % when the cut-off value was kept at 6.2 s. We investigated the performance of a non-invasive technique for measuring tear film stability to aid in the diagnosis of dry eye disease. It is a useful non-invasive objective method for the detection of dry eye, and its varying grades and may be useful in monitoring the efficacy of therapies for dry eye.

Dry eye syndrome is currently seen with increasing frequency throughout the world including India. An evaluation of tear physiology in the form of tear secretion and tear film stability is the most important aspect of dry eye diagnosis. The aim of this study is to investigate the age and gender related changes in the result of these tear function tests (Schirmers Test and Tear Break up time) in normal Indian population. This cross- sectional observational study included 120 normal subjects (60 Male and 60 females) with no ocular symptoms or ocular surface disorders. Schirmer and tear film break-up time tests were assessed in both eyes of each subject. The study subjects were divided into 4 groups according to their ages (<20 y, 20-40 y, 41-60 y and >60 y) each group was composed of 60 eyes of 30 subjects (15 male and 15 female subjects). The One way ANOVA test and the Statagraphic software was used for statistical analysis. We detected a statistically significant decline in both the tear function tests with increasing age. Tear function tests did not show statistically significant difference according to sex. This study suggests that the age of subjects should be taken into consideration in the evaluation of tear function test results. It is also revealed that Indian population values are different from Caucasian and Chinese values. We propose age specific cut off values of tear function tests in Indian population to aid in the diagnosis of dry eye in Indian conditions.

To determine the prevalence of dry eye diseases in general clinical ophthalmic practice in a hospital-based population in West Bengal, Eastern India, a cross-sectional study was undertaken among 3023 subjects with the age of > or = 30 years, attending general ophthalmic clinic in a tertiary eye hospital. Demographics, detailed history and 6-items McMonnies' dry eye questionnaire were asked. Tear film break-up time (TBUT), Schirmer-I test, Rose Bengal (RB) staining, slit lamp examination and Meibomian gland dysfunction (MGD) were studied. Dry eye diseases were significantly higher in women than in men ie, 51.9% versus 48.1% (p < 0.01). Symptom-based dry eye (one or more symptoms present often or most of the time) was diagnosed in 1234 subjects (40.8%). With symptoms and at least one sign [TBUT < 10 seconds, RB staining (van Bjisterveld score: 4 or more) and Schirmer-I test = 5 mm in 5 minutes], the prevalence of dry eye was 786 (26%). Different grades of MeibOmian gland dysfunction (MGD) were detected in 957 cases (31.7%). Primary Sjogren syndrome was found in 21.5%; and 10.9% patients of dry eye had some form of systemic collagen vascular disorders. Using computers was not a risk factor in this geographical area. No significant correlation was seen between significant symptoms and positive signs in the study population. The prevalence of dry eye disease is high in West Bengal, Eastern India in hospital-based population. The risk is higher with age, female gender, systemic collagen diseases and with oral antidepressant/anxiolytic medication. Meibomian gland dysfunction is found to be common among dry eye subjects.

Purpose: To study the effects of air pollution on the eyes of persons staying in the metropolis of New Delhi., Materials and Methods: 400 healthy volunteers from within and outside the metropolis of Delhi were investigated for the presence of tear film abnormalities. All persons underwent slitlamp examination to rule out any ocular surface disorder. The tear break-up time (BUT) was assessed along with a Schirmer test and the tear lysozyme activity and the tear pH were determined., Results: Of the 210 persons staying in the metropolis, 50 (24%) had an abnormal BUT, 14 (6.6%) had an abnormal Schirmer test, and the tear lysozyme activity was found to be low in 12 (5%). In contrast, of those 190 persons living outside the metropolis, only 10 (5.2%) had an abnormal BUT, 4 (2%) had an abnormal Schirmer test, and none had a low lysozyme activity (p < 0.05). None of the persons in either group had significant eye symptoms., Conclusions: Tear film abnormalities are present in a large number of people staying within the metropolis of New Delhi who have apparently normal eyes. Air pollution over a long period of time could possibly be associated with their causation., (Copyright 2002 S. Karger AG, Basel)