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Introduction: Diabetic macular edema (DME) is a vision-threatening complication of diabetic retinopathy. The current practice of management is a" trial and error "method of using intravitreal antivascular endothelial growth factor (VEGF)'' or steroids to treat the patient and watch the response. However, if the patient's genetic profile helps us choose appropriate medicine, it would help customize treatment option for each patient. This forms the basis of our study. Materials and Methods: A case-control, prospective, observational series, where DME patients were treated with bevacizumab and subclassified as treatment naive, treatment responders, and treatment nonresponders. Blood samples of 20 subjects were studied, with five patients in each of the groups (nondiabetic-group 1, treatment naive-group 2, treatment responder-group 3, and treatment nonresponder-group 4). Whole blood RNA extraction followed by labeling, amplification and hybridization was done, and microarray data analyzed. Genes were classified based on functional category and pathways. Results: The total number of genes upregulated among all three experimental groups was 5, whereas 105 genes were downregulated. There were no common genes upregulated between the responders and nonresponders. There was only one gene upregulated between the diabetic and diabetic responders posttreatment. There were 19 genes upregulated and 8 genes downregulated in the inflammatory pathway in group 2 versus group 1. There were no downregulated genes detected in vascular angiogenesis and transcription group. There were identical numbers of genes up-and downregulated in the inflammatory pathway. Seventeen genes were upreguated and 11 genes downregulated in receptor activity, which remained the predominant group in the group classification. Discussion: In summary, this study would provide an insight into the probable signaling mechanisms for disease pathogenesis as well as progression. This type of study eventually would aid in developing or improvising existing treatment modules with a rational approach towards personalized medicine, in future addressing the differential responses to treatment.

We report a 56-year-old male patient, complaining of metamorphopsia in his left eye nevertheless visual acuity, slit lamp, and fundus examinations were within normal limits. Microperimetry (MAIA, Centervue, Italy) revealed central field loss and spectral domain optical coherence tomography (Spectralis, Heidelberg, Germany) showed disrupted cone outer segment tip layer. The patient had a diagnosis of cutaneous melanoma in his foot for which an excision biopsy with lymph node dissection was performed 5 months earlier. Our clinical diagnosis was melanoma-associated retinopathy. Electrophysiology confirmed the diagnosis. Adaptive optics retinal imaging (Imagine eyes, Orsay) was performed to assess the cone mosaic integrity across the central retina. This is the first report on the investigation of autoimmune retinopathy using adaptive optics ophthalmoscopy. This case highlights the viability of innovative diagnostic modalities that aid early detection and subsequent management of vision threatening retinal.

To compare the benefits of initiating Retinopathy of Prematurity (ROP) screening at first contact with the admitted infant prior to hospital discharge ('early screening') with screening performed between 21 and 28 days after birth ('conventional screening') in rural India.Prospective study.Two Level II neonatal intensive care units (NICU), from two district headquarters in Karnataka state.Participants: 329 infants admitted in the two NICUs.One NICU was randomly selected for 'early' and the other for 'conventional' screening. Infants2000 g at birth were targeted for enrolment. Both centres were visited once a week by a dedicated ROP team.The yield of enrolment, and the magnitude of treatment-requiring cases that would be missed in each scenario were estimated and compared.107 of 329 admitted infants were eligible for ROP screening. In the study period of 4 months, 42 and 65 infants were eligible for enrolment in the early and conventional group, respectively. In the early group, 88.1% of eligible infants got screened, compared to 38.5% in the conventional group (P=0.03).Early enrolment of infants for ROP screening in the NICU itself ensures a superior yield compared to conventional age of initiating screening. The recorded information of mothers allowed pre-counselling, improved enrolment and better compliance to the scheduled examinations. These results suggest the need to re-look at the screening guidelines in India and other regions with similar demographics.

Importance Macular edema during infancy, a subclinical feature identified in premature infants by handheld spectral-domain optical coherence tomography (SD-OCT), has been associated with poorer visual acuity and neurodevelopmental outcomes. Features of macular edema on fluorescein angiography (FA) are needed to understand its pathophysiology, but to date have not been reported previously. Objective To investigate the FA features of macular edema during infancy. Design, Setting, and Participants A retrospective review was conducted of 8 infants at Duke Eye Center who received simultaneous SD-OCT and FA imaging from July 1, 2011, to June 30, 2017. Research and clinical care images were obtained during examination of the infants under anesthesia or at the bedside in the neonatal intensive care unit. Main Outcomes and Measures Side-to-side comparison of research handheld SD-OCT images and clinically indicated FA. Results Imaging was conducted at a mean (SD) of 42.8 (4.2) weeks’ postmenstruation age in the 8 infants (1 [13%] female; 2 [25%] African American; 6 [75%] white). Examination of the FA and SD-OCT images found (1) no macular fluorescein leakage in 3 eyes of 2 infants with retinopathy of prematurity without macular edema and 1 eye with a single cyst, (2) equivocal fluorescein leakage in 2 eyes of 1 infant with mild macular edema, (3) late macular fluorescein leakage in 4 eyes of 2 infants with moderate to severe macular edema, and (4) macular fluorescein leakage from posterior preretinal neovascularization in the macula in 4 eyes of 3 infants with retinopathy of prematurity without macular edema. Conclusions and Relevance This observation of fluorescein leakage in 4 infant eyes with macular edema provides new insights into the possible mechanisms of this subclinical finding. Macular fluorescein leakage could indicate a breakdown or delayed maturation of the blood-retinal barrier or dysfunction of the retinal pigment epithelium. Furthermore, the cross-sectional OCT view aids in identifying preretinal neovascularization, which can also cause focal macular leakage in these infants. This new perspective may improve our understanding and potentially guide future treatments of premature infants with subnormal vision.

Background: Poor postnatal weight gain is a well-known risk factor for developing retinopathy of prematurity (ROP). Algorithms that predict ROP based on serial weight gain have not been generalizable in non-Caucasian populations. The duration taken to regain the lost weight is culturally important among Indian mothers. We report the correlation between this duration and the risk of developing ROP. Methods: Sixty-eight Asian Indian infants born Results: The mean BW of the cohort was 1,270±340 grams and mean gestational age (GA) was 31±2 weeks. Thirty-three infants (48.5%) developed no ROP, 20 infants (29.4%) developed type 2 ROP and 15 infants (22.1%) developed type 1 ROP. The mean number of days to regain the lost weight was 11.9+4.6, 17.9+7.9 and 26.6+12.9 days for the No ROP, type 2 and type 1 groups respectively (P Conclusions: The date when a child regains its lost BW is culturally important and easily recalled by mothers. We report the use of this simple estimate as a predictor of ROP. This method could be useful in stratifying risk and predicting the development of “treatment requiring ROP” even before 21 days of life, which is the first mandated screening visit in India.

To assess retinal nerve fiber layer (RNFL) thickness at term-equivalent age in very preterm (32 weeks gestational age) vs term-born infant cohorts, and compare very preterm infant RNFL thickness with brain anatomy and neurodevelopment.Cohort study.RNFL was semi-automatically segmented (1 eye per infant) in 57 very preterm and 50 term infants with adequate images from bedside portable, handheld spectral-domain optical coherence tomography imaging at 37-42 weeks postmenstrual age. Mean RNFL thickness was calculated for the papillomacular bundle (-15 degrees to +15 degrees) and temporal quadrant (-45 degrees to +45 degrees) relative to the fovea-optic nerve axis. Brain magnetic resonance imaging (MRI) scans clinically obtained in 26 very preterm infants were scored for global structural abnormalities by an expert masked to data except for age. Cognitive, language, and motor skills were assessed in 33 of the very preterm infants at 18-24 months corrected age.RNFL was thinner for very preterm vs term infants at the papillomacular bundle ([mean ± standard deviation] 61 ± 17 vs 72 ± 13 μm, P.001) and temporal quadrant (72 ± 21 vs 82 ± 16 μm, P = .005). In very preterm infants, thinner papillomacular bundle RNFL correlated with higher global brain MRI lesion burden index (R(2) = 0.35, P = .001) and lower cognitive (R(2) = 0.18, P = .01) and motor (R(2) = 0.17, P = .02) scores. Relationships were similar for temporal quadrant.Thinner RNFL in very preterm infants relative to term-born infants may relate to brain structure and neurodevelopment.

Purpose. To report pilot data from a novel image analysis software “RetiView,” to highlight clinically relevant information in RetCam images of infants with aggressive posterior retinopathy of prematurity (APROP).Methods. Twenty-three imaging sessions of consecutive infants of Asian Indian origin with clinically diagnosed APROP underwent three protocols (Grey Enhanced (GE), Color Enhanced (CE), and “Vesselness Measure” (VNM)) of the software. The postprocessed images were compared to baseline data from the archived unprocessed images and clinical exam by the retinopathy of prematurity (ROP) specialist for anterior extent of the vessels, capillary nonperfusion zones (CNP), loops, hemorrhages, and flat neovascularization.Results. There was better visualization of tortuous loops in the GE protocol (56.5%); “bald” zones within the CNP zones (26.1%), hemorrhages (13%), and edge of the disease (34.8%) in the CE images; neovascularization on both GE and CE protocols (13% each); clinically relevant information in cases with poor pupillary dilatation (8.7%); anterior extent of vessels on the VNM protocol (13%) effecting a “reclassification” from zone 1 to zone 2 posterior.Conclusions. RetiView is a noninvasive and inexpensive method of customized image enhancement to detect clinically difficult characteristics in a subset of APROP images with a potential to influence treatment planning.

Purpose To describe the correlation between the surface morphology on spectral-domain optical coherence tomography (SD-OCT) and leakage pattern on fundus fluorescein angiography (FFA) in an infant with multiple retinal hamartomas. Methods An Asian Indian female infant was found to have 2 retinal lesions in the right eye and 1 in the left eye during Retcam (Clarity MSI, CA, USA) screening for retinopathy of prematurity at 45 weeks postmenstrual age. Spectral-domain optical coherence tomography on the hand-held OCT (Envisu 2300, Bioptigen, NC, USA) and FFA on the Retcam 3 were performed under monitoring in the office. Results Spectral-domain OCT detected all 3 lesions but only 1 lesion was detected on FFA. While this lesion had an irregular surface with overlying vitreoretinal (VR) traction on SD-OCT, the other 2 lesions not detected on FFA were smooth and had no VR traction. After a follow-up to 18 months corrected age, there was no change in the morphology of any of the lesions. Conclusions It is possible to characterize retinal hamartomas in infants using SD-OCT and correlate them with FFA. Spectral-domain OCT examination can be used to diagnose and monitor lesions even if they are not detectable on angiography.

Purpose: To compare single versus 2-session laser photoablation for flat neovascularization in cases with Zone 1 aggressive posterior retinopathy of prematurity.Methods:Twenty-nine Asian Indian infants with aggressive posterior retinopathy of prematurity were randomized; each eye received 1 of 2 methods (29 each in Group A or B) proposed by the PHOTO-ROP group. Group A underwent single session laser to the avascular retina underlying the flat neovascularization by direct laser over the fronds. Group B underwent laser in 2 sessions; first, laser was delivered to the avascular periphery up to the flat neovascularization and 7 days later to the avascular bed exposed by the retraction of the fronds. Outcome and complications between the two groups were compared.Results:Mean birthweight and gestational ages were 1,276 g and 30.1 weeks, respectively. All eyes showed favorable outcome at a minimum 12-month follow-up. Hemorrhages after laser (41.4% vs. 17.2%, P 1 disk diameter) seen in Group A took longer than 8 weeks to resolve and developed focal fibrosis.Conclusion:This study demonstrates that the two-staged laser procedure produces fewer and smaller hemorrhages and no fibrosis compared with a single session. Both methods have comparable favorable outcomes in Asian Indian infants.

To describe the parafoveal cone arrangement in emmetropic subjects and its variations with eccentricity, meridians and change in axial length in Indian eyes.We imaged 25 subjects using compact adaptive optics (AO) retinal camera prototype, the rtx1. Imaging was done at 1, 2, and 3° eccentricity from the fovea in four meridians: nasal, temporal, superior, and inferior.A statistically significant drop in the cone packing density was observed from 2 to 3° (2° eccentricity=25 350/mm(2) (5300/mm(2), 8400-34 800/mm(2)) 3° eccentricity=20 750/mm(2) (6000 mm(2), 9000-33 670/mm(2))) P0.05. The spacing correspondingly increased with increase in distance from the fovea (2° eccentricity=6.9 μm (0.70 μm, 5.95-11.6 μm)) and 3°eccentricity=7.80 μm (1.00 μm, 6.5-13.5 μm) P0.05. As the axial length increases, the cone density significantly decreases. Interocular variations were noted.With the advent of AO, visualization at the cellular level is now possible. Understanding the photoreceptor mosaic in the parafoveal space in terms of its density, spacing, and arrangement is crucial so as to detect early pathology and intervene appropriately. Newer therapeutic modalitites that are targeted at the cellular level like yellow micropulse laser, stem cells, gene therapy and so on may be better monitored in terms of safety and efficacy.

AIM: To assess the variations in cone mosaic in myopia and its correlation with axial length (AL). SUBJECTS AND METHODS: Twenty-five healthy myopic volunteers underwent assessment of photoreceptors using adaptive optics retinal camera at 2 degrees and 3 degrees from the foveal center in four quadrants superior, inferior, temporal and nasal. Data was analyzed using SPSS version 17 (IBM). Multivariable regression analysis was conducted to study the relation between cone density and AL, quadrant around the fovea and eccentricity from the fovea. RESULTS: The mean cone density was significantly lower as the eccentricity increased from 2 degrees from the fovea to 3 degrees (18,560 +/- 5455-16,404 +/- 4494/mm 2 respectively). There was also a statistically significant difference between four quadrants around the fovea. The correlation of cone density and spacing with AL showed that there was a significant inverse relation of AL with the cone density. CONCLUSION: In myopic patients with good visual acuity cone density around the fovea depends on the quadrant, distance from the fovea as well as the AL. The strength of the relation of AL with cone density depends on the quadrant and distance.

Purpose: The purpose of this study was to report the spectrum of anterior and posterior segment diagnoses in Asian Indian premature infants detected serendipitously during routine retinopathy of prematurity (ROP) screening during a 1 year period. Methods: A retrospective review of all Retcam (Clarity MSI, USA) imaging sessions during the year 2011 performed on infants born either

Correction to: Eye (2014) 28, 1488–1493; doi:10.1038/eye.2014.229; published online 3 October 2014 Since the online publication of the above article, it has been noted that the name of the fifth author was published incorrectly. The correct name is given above. This error has now been rectified, andthe corrected article appears in this issue.