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Background: Uveitis is associated with several systemic disorders. It may be the initial presentation or manifestation of a systemic disease. It is the most common ocular complication and is sometimes the earliest manifestation of spondyloarthropathies. This study aimed to review the current literature on spondyloarthropathies and associated uveitis. Methods: A narrative review was performed using various combinations of the keywords spondyloarthropathies, seronegative spondylarthritis-related uveitis, and human leukocyte antigen-associated uveitis using PubMed/MEDLINE and Google Scholar from January 1, 2000, to September 30, 2022. We describe the disease mechanisms, genetics, and classification of spondyloarthropathies, the clinical patterns of their related ocular diseases, and the current modalities for the management of their ocular or systemic manifestations. Results: Seronegative spondyloarthropathies are a group of rheumatic disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease-related spondyloarthropathy, juvenile-onset spondyloarthritis, and undifferentiated spondyloarthritis. These are characterized by enthesitis in the absence of serum rheumatoid factor and have a strong association with human leukocyte antigen B27. The clinical courses and features of spondyloarthropathies are remarkably diverse. Ocular inflammation is common in spondyloarthropathies, often precedes the onset or diagnosis of systemic disease, and responds well to topical therapy. Timely diagnosis of systemic diseases may improve quality of life and help avoid ocular and skeletal complications. Recurrence of ocular inflammation is frequent; on occasion, it may be associated with etanercept administration. Conclusions: Eye care professionals should be able to recognize spondyloarthropathies, manage ocular disease, and collaborate with related specialties for modification of systemic treatment if associated with ocular complications. Timely referral and early management could attenuate or prevent ocular or systemic morbidities associated with spondyloarthropathies.

Aim: To survey eye-care professionals in Pakistan, including optometrists, ophthalmologists, and residents from either, on their knowledge, opinions, and clinical practice patterns. We also looked to see if their myopia-related practice habits were in accordance with current standards of care and guidelines. Methods: An online survey was created and shared with eyecare providers from all provinces in Pakistan. The responses were collected over a span of 8 weeks. Results: 173 professionals took part in the survey and 146 were able to complete the survey (based on their response to specific questions). Most common method of refraction was cycloplegic refraction, and most tended to under-correct myopia. Only 1/4th of clinicians were measuring axial length and 21% never performed binocular testing and checked lag of accommodation in myopes. Most common method of myopic fundus examination was dilated fundus biomicroscopy and criteria for peripheral fundus examination was myopia greater than 6 diopters. Almost half have not attended a course/ workshop on myopia (control) in past 6 months and 1/4th tended to rarely read a myopia related journal article. Progression of more than 1 diopter a year was criteria for initiation of control strategies for most clinicians and 0.01% atropine was the preferred initial concentration and almost half of them believed the control strategies to be moderately effective. Conclusion: A substantial proportion of eyecare providers do not appear to be aware of current concepts and do not incorporate recent guidelines into their practices regarding myopia management. Keywords: Practice patterns, Eye care providers, Myopia

Artificial intelligence in ophthalmology and visual sciences: Current implications and future directions

Purpose: To evaluate the role of cycloplegic agents in diagnosis and management of accommodative spasms. Methods: Prospective cohort study included patients with recent onset ocular strain. All patients underwent comprehensive eye examination and objective refraction. Then patients were randomized to receive either atropine or cyclopentolate for cycloplegia. And objective refraction was recorded again. Patients were randomly assigned to one of the two treatments i.e.full cycloplegic correction or 0.001% atropine and reviewed at 1-, 2- and 3-month follow-ups. Results: Total 52 patients, mean age16.1±4.7 were evaluated. 33 patients (63.5%) received atropine and 19 (36.5%) received cyclopentolate. There was significant difference between precycloplegic and post cycloplegic refraction however, the difference between cyclopentolate and atropine was not significant. None of the patients, whether treated with glasses or low dose atropine experienced any ocular strain till the end of study. Conclusion: Both cyclopentolate and atropine are equally effective in achieving adequate cycloplegia in patients with accommodative spasm. Plus corrective wear or low dose atropine are equally effective in relieving the symptoms of patients. Keywords: Cycloplegic agents, Post-cycloplegic refraction, Accommodative spasm

Purpose:Thepurposeofthis workwastodescribeidiopathicretinalvasculitis,aneurysms,andneuroretinitis(IRVAN)syndrome ina32-year-oldmale.Methods: Casereport.Case report: A 32-year-old male presented with acute visualdisturbance. Multimodal imaging revealed retinal vasculitis,aneurysmsandneuroretinitisinadditiontovitreousinflammation,retinalischemiaandepiretinalmembrane.Opticalcoherencetomographyangiography(OCTA)demonstratedmultiplemicroaneurysm inbotheyes.Conclusion: Multimodal imaging was helpful in diagnosinganddifferentiatingIRVANsyndromefromothersimilar-lookingclinicalentities.Retinalaneurysmsandretinalischaemiaweredetectablebyfundusfluoresceinangiography(FFA). However, OCTA showed multiple microaneurysmsthatwerenotclearlydifferentiablebyFFAbecauseofvitreousinflammationandvascularleakage.MicroaneurysmsinIRVAN syndrome area previously unreportedobservation.OCTAmayhelpdetectthesechangeswithaccuratedetails

Aim: To evaluate the impact of public eye health campaigns on people's attitudes during the solar eclipse. Methods: Retrospective chart review of patients with solar eclipse retinopathy. Hazard awareness, source of information, and types of self-proclaimed safety measures were analyzed. It was a multicenter study conducted at Ophthalmology departments of different hospitals of Faisalabad, Gilgit, Sialkot and Dera Ismail Khan for one month from July 2020 to August 2020. Results: Data of a total of 31 patients were analyzed. Twenty-two (71%) patients had hazard awareness either from the internet or mainstream media, while 9 (29%) had no understanding of eclipse viewing hazards. Eleven patients had some idea about appropriate eclipse viewing glasses while none used them. Thirteen (42%) patients didn't use any protective measures, while the rest either used radiographic films or sunglasses (SG). Knowledge, availability and affordability were significant barriers towards using standard safety wear. There was no difference among patients who viewed the eclipse with the naked eye or with sunglasses and radiographic films in terms of initial and final visual outcomes. Conclusions: Most patients are aware of potential visual hazards from viewing solar eclipse; however, they are not well educated about appropriate ocular safety wear for viewing a solar eclipse. Keywords: Solar eclipse, Retinopathy, Health concern

To assess the reliability and validity of gray level co-occurrence matrices (GLCM) in the quantification of choriocapillaris and describe GLCM features in normal and eyes with resolved acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis (SC).In this, multicenter, reliability, validity and comparative study; OCTA was performed on eyes with resolved APMPPE and SC and normal individuals. CC texture classification, low flow area measurements and GLCM feature extraction were performed.A total of 13 normal, 8 APMPPE and 15 SC eyes were analyzed. All GLCM parameters demonstrated an excellent reliability. GLCM parameters were differently distributed across the three groups. Decision-tree based on the random forest predictive model provided an overall accuracy of 86% in classifying the three groups using GLCM features.These data demonstrated an excellent reliability and validity of GLCM features in quantifying the choriocapillaris in healthy and diseased eyes.

BACKGROUND/OBJECTIVES: To analyze the ophthalmic characteristics of congenital prepapillary vascular loop (PVL) and to propose a new morphologic classification dividing the loops into six types. SUBJECTS/METHODS: Collaborative multinational multicentre retrospective study of PVL cases. RESULTS: There was a total of 49 cases (61 eyes), 37 unilateral (75.5%) and 12 bilateral (24.5%), 32 arterial type (65.3%) and 18 venous type (36.7%) (one patient had either kind in each eye). The mean number of loops per eye was 2.7 (range, 1-7). The loops were asymptomatic in 42 cases (85.7%). Other findings included: the presence of cilioretinal artery (14 cases), retinal vascular tortuosity (26 cases), amaurosis fugax (1 case), branch retinal artery occlusion (1 case) and vitreous haemorrhage (3 cases). Six morphologic loop types could be discerned based on elevation (flat vs. elevated), shape (figure of 8 or corkscrew with hyaline sheath), number (multiple or single), location (central or peripheral), lumen size (arterial vs. arteriolar) and presence of vascular tortuosity or vitreous traction. CONCLUSIONS: PVL are usually asymptomatic and can be divided into six morphologic types with different pathogenesis during early embryogenesis.

The purpose of this study is to report eyelid myokymia in patients recently recovered from COVID-19 disease. A cohort of 15 patients who developed eyelid myokymia during or immediate post-recovery of systemic disease were evaluated. Demographic, clinical characteristics, effect of age, and hospitalization on the disease course were studied. The disease course was evaluated every month for 3 months period. All, except 2, patients had complete resolution of lid myokymia within 3 months of onset. Median [IQR] myokymia recovery time was 42 [31,60] days. Age and duration of hospitalization had a significant linear relationship with myokymia recovery time. Recovery was delayed by 2.64 days with every 1-year increment in age and by 6.19 days with every additional day of hospital stay. Recovery time was independent of severity of systemic disease (P = .055) and gender (P = 0.2). Eyelid myokymia can be a possible manifestation of COVID-19 recovery phase. While myokymia recovers gradually in all these patients, older age and a longer duration of hospitalization are associated with slower recovery.

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare spectrum of retinal vasculitis, aneurysms, and neuroretinitis affecting young individuals in their third decade. Most of our current knowledge is based on case reports, case series, and a handful of collaborative studies. There is much diversity in treatment approaches and outcomes in the reported literature. We have aggregated published case reports and case series into quantitative and narrative synthesis to draw evidence-based conclusions toward clinical features, atypical and rare findings, systemic associations, disease course, and treatment outcomes. The analysis suggested the disease mostly affects young individuals with a female predilection. Anterior chamber and vitreous inflammation are common than previously believed. The most prevalent pattern of retinal vasculitis in IRVAN eyes is mixed vasculitis, followed by arteritis and phlebitis. Most eyes at the time of presentation have capillary nonperfusion and require treatment. Most eyes retain good visual acuity; however, treatment is required to maintain visual function. Intravitreal antivascular endothelial growth factors administered as an adjunct to retinal laser photocoagulation are more likely to improve visual outcomes. Besides, we have discussed the different hypotheses on the etiopathogenesis of the disease and stronger evidence suggests an inflammatory origin of the disease.

Background: von Hippel-Lindau (VHL) syndrome is a multisystem neoplastic disorder involving eyes, central nervous system, kidneys, spine, and other tissues. A retinal capillary hemangioma (RCH) is the earliest manifestation of the VHL disease in most cases.Areas covered:This paper aims to provide an up-to-date review of the current literature about von Hippel-Lindau syndrome. Molecular background, systemic and ocular features of the diseases as well as the utility of newer imaging modalities in diagnosis and monitoring of ocular VHL disease have been described. Besides, we have discussed newer treatment modalities and therapeutic targets.Conclusion: Modern imaging technologies like optical coherence tomography and optical coherence tomography angiography are tools of the trade, in making an appropriate diagnosis and monitoring disease activity and response to treatment. Peripheral RCH may be treated using laser photocoagulation in tumors up to 3000 µm. Vascular endothelial growth factor suppression can help in reducing tumor activity and stabilize the tumor size; however, it does not regress the RCH.

BACKGROUND AND OBJECTIVE: To evaluate the flow characteristics and textural properties of choriocapillaris (CC) on optical coherence tomography angiography in eyes with resolved inflammatory choriocapillaropathies and Vogt-Koyanagi-Harada (VKH) disease. PATIENTS AND METHODS: A cohort of eyes with healed acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis (SC), and VKH disease were included. A 3 mm × 3 mm OCT angiogram of CC was acquired and graded for flow characteristics and textural properties. RESULTS: This study included 16 patients. Texture was heterogeneous in all eyes in the SC and VKH groups, and in four eyes (40%) in the APMPPE group. Most of the eyes with VKH disease had severe low flow, whereas most of the SC and APMPPE eyes demonstrated mild low flow. Heal duration had a strong negative correlation with severity of CC low flow and a weak, statistically nonsignificant correlation with texture heterogeneity. CONCLUSION: Despite the resolution of active inflammation, partial CC hypoperfusion and texture disruptions persist for longer durations and may resolve in a time dependent manner. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:566–572.]

Purpose To report the eyelid myokymia in patients recovered from COVID-19 disease. Methods A cohort of 15 patients who developed eyelid myokymia during or immediate post-recovery of systemic disease were evaluated. Demographic, clinical characteristics, effect of age, and hospitalization on the disease course were studied. The disease course was evaluated every month for 3 months period. Results All, except 2, patients had complete resolution of lid myokymia within 3 months of onset. Mean ± SD myokymia recovery time was 44.1 ± 20.9 Days. Gender had no impact on the duration of disease. Age and duration of hospitalization had a strong positive correlation with myokymia recovery time (r = 0.8, p = 0.001 and r = 0.8, p = 0.01). Conclusion Eyelid myokymia may involve COVID-19 patients during or immediately after systemic recovery. While myokymia recovers gradually in all these patients; older age and longer duration of hospitalization are associated with slower recovery.

Purpose: Purpose of this study is to determine the effect of weight and height on intraocular pressure (IOP) and to compare effect of height and weight on IOP in males and females. Methodology: This cross-sectional study was carried on 114 subjects through non-probability convenient sampling technique, both gender and age ranging from 15 to 30years who had not undergone any ocular surgery or medical treatment for hypertension glaucoma diabetes. The data collected from the patients at the department of ophthalmology during time of 8am-2pm in Madinah teaching hospital, Faisalabad in duration of 7months from January 2018 to August 2018. Data was collected after taking consent and extensive history. Visual acuity was tested by using Snellen chart and IOP measured by Air puff tonometer and weight measured by weight machine in Kgs and Height measured by Hight scale in feet. Data was noted on Performa. Data was analyzed by using test multiple linear regressions by using SPSS version 20. Result: Total number of studied individuals were 114, 48(42%) males and 66(57.9%) females with age ranges from 15-30 years. Weight and Height was measured and tested relation with IOP and gender by using Linear multiple regression test. Analysis shows that relation of weight and IOP is significant (p

Introduction: Recent innovations in ophthalmic imaging have led to new alternatives to conventional ocular angiography. We describe different methods of label-free angiography and their clinical utility in ophthalmic practice.Areas covered: The aim of this paper is to review the current literature on Optical Coherence Tomography Angiography (OCTA). A review of the literature was performed, including the physical principles and algorithms and OCTA features of different ocular diseases. The literature reviewed was found by searching Pubmed and Google Scholar for optical coherence tomography, OCT angiography, and label-free angiography. All results in the English language were read in full-text.Expert commentary: OCTA is an emerging, non-invasive imaging modality which can display ocular vasculature with good sensitivity and may help us detect vascular disorders of the retina and choroid. The technique’s depth-resolving ability allows us to localize the origin of several disorders to the individual v...

Purpose To report a case of atypical serpiginous choroiditis with previously unreported findings on optical coherence tomographic angiography. Case report A 35-year-old otherwise healthy man had a 1-week history of vision loss in his right eye. The visual acuity in right eye was counting fingers at 1 meter. Fundoscopy showed a classic peripapillary serpiginous lesion and a solitary macular lesion. Fundus fluorescein angiography revealed early hypofluorescence of active lesions with gradual increase in fluorescence across the phase of angiogram. Optical coherence tomography showed hyperreflectivity in outer retinal layers and loss of ellipsoid zone band. The patient was treated with oral prednisone and visual acuity returned to near normal. The inflammation recurred once the patient discontinued corticosteroid therapy. The flare-up was treated with intravenous methylprednisolone followed by oral steroids. Oral azathioprine was added as a steroid-sparing agent and oral prednisone was tapered slowly and discontinued. The visual acuity returned to normal with settlement of all lesions after initiating azathioprine. Optical coherence tomography showed reintegration of retinal anatomy. No recurrence was seen after discontinuation of corticosteroids. Optical coherence tomographic angiography in resolved serpiginous choroiditis was consistent with loss of choriocapillaris homogeneity. Conclusions Serpiginous choroiditis may manifest with multifocal lesions and may be confused with relentless placoid chorioretinitis. However, it ends up in a typical geographic scar. Optical coherence tomography can be used to monitor the changes in retinal structure. Choriocapillaris changes as seen on optical coherence tomographic angiography may be a possible mechanism behind the development of choroidal neovascularization in later stages of the disease.

Purpose: To determine blue color vision defect in type II diabetics and to compare it with the duration of diabetes. Methodology: Cross-sectional study was conducted at Abdullah Memorial Hospital on 120 eyes of type-II diabetics in duration of 5 months from August 2018 to January 2019. Sample was collected through non-probability convenient sampling technique. Subjects with minimum 6/12 vision with or without correction were included and age group 35 to 65 years of both genders. Eye of diabetic type 2 without any sign of retinopathy were included. Any individual with congenital color vision defect, retinal, optic nerve or choroidal lesion was excluded. Ishihara plates were used initially to screen out congenital defects. Later, D-15 test was performed for evaluation of color vision for acquired changes due to diabetes. Data was entered using latest version 20 of SPSS and chi-square was used to assess association between color anomaly and type-II diabetes. Results: In a sample of 120 eyes, 60% of population is Trichromate, 30% of population is tritanomalous, 1.7% population is deuteranomalous and 8.3% population is both deuteranomalous and tritanamolous. Comparison of blue color sensitivity in diabetic patients before onset of retinopathy was evaluated using Chi square with p value .000 at the level of 5% of confidence interval that shows highly significant results. Results conclude that there is strong association between blue color vision defects in diabetics. This defect was observed more with increase in duration of diabetes. Conclusion: Study concluded that diabetic type 2 patients have impaired color vision specifically triatanomaly. Color vision must be evaluated and assessed in every diabetic patient and should be made an early assessment and screening tool. Timely assessment of color vision may detect tritanomaly earlier in type 3 diabetics.

Purpose To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with atypical features. Case report A 30-year-old otherwise healthy woman presented with a 7-day history of visual disturbance in her left eye. The best corrected visual acuity in her left eye was 6/36. Funduscopy revealed multiple cream-colored placoid lesions, serous macular elevation, and papillitis. Fundus fluorescein angiography revealed early hypofluorescence and late hyperfluorescence. Systemic and neurologic assessments were normal. The case shared features with both APMPPE and Harada's disease, making it a diagnostic challenge. However, APMPPE may rarely mimic Harada's disease when it manifests with atypical features, like serous retinal detachment and papillitis. The patient was managed with oral prednisolone with slow tapering. Her visual acuity improved gradually to 6/12. Neither involvement of fellow eye nor recurrence in same eye was noted for a period of 1 year. Conclusions Acute posterior multifocal placoid pigment epitheliopathy may rarely manifest with atypical features, including papillitis and serous retinal detachment, perplexing the diagnosis and management.