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Purpose: To assess the quality of life and contrast sensitivity (CS) pre- and post-laser assisted in situ keratomileusis (LASIK) among subjects with low, moderate and high myopia. Materials: A total of 95 ubjects undergoing myopic LASIK during the study period from 2018 to 2019 among different grades of myopia were included. It was a prospective, non-randomised study. Quality of life was measured by NEI-RQL 42 (national eye institute refractive error quality of life) questionnaire. The Pelli-Robson chart measured contrast sensitivity and the visual outcomes before LASIK and at one week, one month and six months after LASIK. Results: One hundred and ninety eyes of 95 subjects were included in the study. Out of these, 93.5% of low myopia (n = 29/31), 85.7% of moderate myopia (n = 36/42) and 72.7% of high myopia (n = 16/22) improved to 6/6 at six month follow up. All 13 subscales of the NEI-RQL 42 questionnaire observed an increasing trend except glare (GL) which showed a decreasing trend over time, and the results were statistically significant at a 5% level. Concerning contrast sensitivity, low myopias had a better postoperative CS when compared to high myopia, and this finding was statistically significant (P = 0.012). Conclusion: Despite being a safe and effective procedure of refractive correction, LASIK has its setbacks, especially when compared with the quality of vision, and this can be minimized by careful preoperative assessment and in-depth patient counseling by the treating physicians.

Purpose: To compare the surgical outcomes of trabeculectomy with and without anti-metabolites in patients with juvenile open-angle glaucoma (JOAG). Methods: This retrospective comparative case series included 98 eyes of 66 patients with JOAG who underwent either trabeculectomy without anti-metabolites (group A, n = 53 eyes) or with anti-metabolites (group B, n = 45 eyes) with a minimum of 2 years follow-up. The main outcome measures were intra-ocular pressure (IOP), number of glaucoma medications, visual acuity, additional surgical interventions, surgical complications, and risk factors for failure. Surgical failure was defined as IOP >18 mmHg or failure to reduce IOP by

Purpose: To evaluate the determinants affecting the quality of life in monocular glaucoma patients using the Indian vision function questionnaire. Methods: In this prospective cross-sectional study, total of 196 patients were divided into two groups: cases and controls. Indian Vision Function Questionnaire (IND-VFQ) was administered and analyzed. One hundred twenty-nine (58.6%) patients who had lost their vision in one eye due to glaucoma were included as cases and 67 (30.4%) patients who had lost their vision due to other causes were taken as controls. Results: Median composite score of subscales was 54.62 (29.7–74.7) in group 1 and 45.38 (23.7–76.7) in group 2. The psychosocial impact scale was the most affected scale, the median scores were 33.02 (0 to 60.0) and 19.07 (0 to 53.0) in groups 1 and 2, respectively. Among all dimensions of IND-VFQ, the highest score was for color vision 100.0 (0–100.0) and 100.0 (0–100.0), and the lowest median score was found in mental health and dependency in both the groups. Multiple linear regression analysis demonstrated that visual acuity was associated with a low score (P < 0.001). Female gender was significantly associated with the overall score in the univariate model (P = 0.006). Conclusion: Monocular glaucoma patients have a poor general and vision-related quality of life. Depression associated with monocularity and the perception of dependency and being a burden on their family members greatly impacted the mental health of the participants.

Purpose: The purpose of this study is to study the patient's awareness of the proper method of eye drop (ED) opening and usage among patients attending the outpatient and specialty clinics of a tertiary eye care center in South India. Methods: A questionnaire-based cross-sectional survey was conducted among 514 patients attending outpatient departments of general units and specialty clinics by seven study coordinators. The questionnaire consists of 10 simple questions to assess the awareness of these patients on ED opening, usage methods, and from whom they received the information. Immediately, at the end of the questionnaire, all the patients participating in the survey were properly instructed on the right method of ED usage. In addition, they were inquired about the right mode of communication on the topic of interest. Results: Total number of participants included was 514. Mean age was (standard deviation) 50.58 (20.8) years; only 3.3% (17) were not informed about the proper usage of ED method by any of the staff or the counselors or doctors from the hospital, and 96.7% (497) were counseled for the proper method of ED usage. Among them, the information was properly explained to 82.7% (412) of the respondents by the counselors in each department; only 7.4% (37) were explained by the doctors. Most of them, 80.2% (412), preferred direct oral conversation methods of counseling on ED usage, 9.9% (51) preferred through posters, 7% (36) through video displays, and only 9% (10) through public address systems. Conclusion: A separate, precise ED counseling system is necessary for delivering proper instructions on ED usage and opening. The patient's education with eye-to-eye contact from the counselors is the patient's preferred route of obtaining information on ED usage.

Purpose: To study the prevalence and determinants of compliance with spectacle wear among school-age children in South India who were given spectacles free of charge under a school vision screening program. Methods: A cross-sectional, descriptive study was performed. The participants were recruited from the school from Tirunelveli and Tuticorin districts of Tamil Nadu, where a school vision screening camp was conducted between January 2012 and October 2012. The school screening was performed under “Lavelle Pediatric Eye Care Project” . Of the 129,720 children examined of 249 schools, 4253 of children had refractive error and 3333 were prescribed and dispensed spectacles. A total of 683 children were interviewed, who were not wearing glasses on follow-up. Results: About 20% of the participants (683/3333) were not wearing their spectacles at examination. The most common reasons given for non-wear were lost (44.9%) or broken (35.3%) spectacles. There was no gender preference on compliance to spectacles. Conclusion: Compliance with spectacle wear is less even when spectacles are provided free of cost, particularly in children among the age group of 5–15 years. Because factors such as type of school, area (urban or rural), parent's income, occupation, and their education were not significantly affecting the compliance of spectacle wear, proper encouragement and counseling of the parents and the child become extremely important.

Purpose: To compare the effect of audiovisual and verbal instructions on patient performance while performing automated Humphrey visual field testing. Methods: This was a prospective study. A total 120 patients divided into groups of 40 each were recruited from the glaucoma outpatient department (OPD). All patients were aged 35–75 years with no previous experience of performing HFA. Patients with hearing impairment, any other cognitive impairment, and best-corrected visual acuity (BCVA) ≤6/36 on Snellen's visual acuity were excluded. The first two groups were given strict (conservative) and lenient (liberal) verbal instructions. The instructions were adapted from those listed in the manufacturer's instruction. and the third group was shown a standard video depicting in detail how perimetry was to be performed. A questionnaire was given to each patient before and after the test to assess the patient's performance. Results: Patients diagnosed with glaucoma during testing in each group were 29 (72.50%), 30 (75.0%), and 33 (82.5%) in the video instructed, strictly verbal, and leniently verbal groups, respectively. The overall mean deviation (MD) in the right eye (RE) was of − 3.38 (−4.9 to 1.9) and in the left eye (LE) was − 3.96 (−6.4 to − 1.9). Reliable field was slightly higher for the video instructed group (47.5%) and lowest for the strictly verbal group (22.5%) (P = 0.033). A higher number of patients were very motivated in the video instructed group (27%) (P = 0.041). Post-test questionnaires showed that 40% of patients felt they have performed the test with 100% accuracy in video group with less guessing. A higher number of patients in the video instructed group (85%) felt instruction was helpful in performing the test (P = 0.001). Conclusion: The video groups were more motivated and had better confidence to perform the test with less anxiety and stress and with probably better understanding of the procedure due to visual effects enhancing their understanding.

Purpose: To find out parents' knowledge, attitude, and treatment practice (KAP) toward pediatric eye problems and to assess the effect of demographic factors such as gender, age, educational status, and number of children on KAP. Methods: A cross-sectional descriptive study was conducted in a hospital setting. Two hundred parents were randomly selected for the questionnaire. All parents had children who were included in Systematic Pediatric Eye Care Through Sibling Screening Strategies (SPECSSS) study. A survey with 15 questions on KAP of pediatric eye diseases was prepared and administered to parents coming to a tertiary eye hospital with varied experience and education qualifications. Results: The mean age of 200 patients was 9.6 (3.4) years, with the majority of them male (n = 110; 55.0%). The majority of the children (n = 91, 45.5%) were between the age group of 6–10 years. Knowledge of visual problems among parents was of a good grade in 9% only. The attitude of the parents toward the visual problem was positive at 17%, and the responses regarding the practice were of excellent grade at 46.5% and good at 26.5%. Analysis suggests that the level of knowledge and practice were not significantly associated with the demographic factors (p > 0.05). The positive attitude toward the visual problems of the children was associated with education of the parents (p < 0.05) and the father occupation (p < 0.05). Conclusion: Knowledge about pediatric eye diseases was poor among parents and it was significantly affected by education and occupation of parents. The parents have positive attitude toward enhancing their attitude in treatment.

Purpose: To study the refractive profile of children after they received intravitreal injection of bevacizumab for retinopathy of prematurity (ROP). Methods: The study was conducted at a tertiary eye care hospital in South India. ROP patients of more than 1 year of age, presenting to the Pediatric Ophthalmology Clinic and Retina Clinic and having history of treatment for type I ROP with intravitreal bevacizumab (IVB) or intravitreal bevacizumab and laser photocoagulation were included in the study. Cycloplegic refraction was done, and the refractive status was evaluated. The refractive status of age-matched, full-term children with uneventful perinatal and neonatal history was also recorded and compared to the study group. Results: Among 134 eyes of 67 study subjects, the major refractive error was myopia in 93 eyes (69.4%; spherical equivalent [SE] = −2.89 ± 3.1, range = −11.5 to −0.5 D). There were 75 eyes (56%) with low-to-moderate myopia; high myopia was seen in 13.4%, emmetropia in 18.7%, and hypermetropia in 11.9% of eyes. The majority of them (87%) had with-the-rule (WTR) astigmatism. In 134 eyes, the SE was −1.78 ± 3.2 (range = −11.5 to 4 D); the SE of the 75 eyes with low-to-moderate myopia was −1.53 ± 1.2 (range = −0.50 to −5 D). In the control group, the majority had emmetropia (91.8%). There was no significant association between the age at which IVB had been injected and the development of refractive errors (P = 0.078). The prevalence of low-to-moderate myopia was more than high myopia in patients with zone I and zone II ROP before treatment (60.0% and 54.5%, respectively). Conclusion: Myopia was the major refractive error seen in post-IVB pediatric patients. WTR astigmatism was more commonly seen. The age at which IVB injection had been given had no effect on the development of refractive errors.

Aims: To assess the differences in ocular morbidity with/without visual impairment between rural and urban school-going children using a two-step screening strategy. Methods: Data obtained by a hospital team from school camps conducted between the 1st of February 2019 and the 31st of December 2019, in schools with a strength of at least 1,000 students were reviewed retrospectively. The differences in ocular pathologies between the rural and urban cohorts were evaluated. A P < 0.05 was considered significant. Results: Out of 25,132 students (nurban = 12,562; nrural = 12,570), 14.44% (nurban = 1,585; nrural = 2,044; P < 0.001) were selected for evaluation by the hospital team after a primary screening by their class teachers. A statistically significant difference was noted in the frequency of refractive errors (urban = 6.8%; rural = 6.0%; P = 0.01), allergic conjunctivitis (urban = 0.2%; rural = 0.05%; P = 0.001), and amblyopia (urban = 0.03%; rural = 0.12%; P = 0.009) between urban and rural children. Simple and compound myopic astigmatism were significantly more common in urban children (p < 0.001 and 0.03 respectively). There was no significant difference in the incidence of spectacle use (P = 0.11) between the two cohorts. A Cochran--Armitage trend test revealed a statistically significant increase in the proportion of myopia with age among the children evaluated by the hospital team (p < 0.001). Conclusion: Allergic eye disease and myopic astigmatism are commoner in urban children. Routine ophthalmic screening is required to identify uncorrected refractive errors and amblyopia, especially in rural school children.

Purpose: To evaluate the outcomes and identify favorable prognostic factors in patients of phacomorphic (PMG) and phacolytic glaucoma (PLG) managed by manual small-incision cataract surgery (MSICS). Methods: The medical records of patients with PMG/PLG who had undergone MSICS in a tertiary eye hospital between September 2014 and August 2018 were retrospectively reviewed. Regression analyses were conducted to identify the predictors associated with intraoperative or postoperative complications and a favorable final outcome at 1 month, namely, a best-corrected visual acuity (BCVA) of 6/18 or better and an intraocular pressure (IOP) of

Purpose: To compare the clinical and biometric characteristics of children presenting with nanophthalmos (NO group) with that of age-matched controls (CO group). Methods: Electronic medical records of 40 children (17 mm. Multivariable regression analysis revealed a significant correlation of SE and ACD with AxL. Conclusion: Nanophthalmos in children often present as amblyopia with visual impairment and strabismus. NO group with AxL

Purpose: The purpose of this study is to compare the endothelial cell loss (ECL) in nanophthalmic eyes and age-matched controls undergoing cataract surgery by phacoemulsification and also to identify the risk factors influencing the endothelial cell density (ECD). This was a prospective comparative interventional case series. Methods: We enrolled 19 nanophthalmic eyes (study group) and 42 age-matched cataract controls (control group) undergoing phacoemulsification after meeting the inclusion criteria. Ocular parameters like best-corrected visual acuity, intraocular pressure, pachymetry, specular microscopy, and slit lamp findings were noted preoperatively and at month 1 and 3 postsurgery. All nanophthalmic eyes underwent cataract surgery with concomitant prophylactic posterior sclerostomy. Results: The median percentage endothelial loss in nanophthalmic eyes was 4.0 (IQR 0–23.5), 7.4 (IQR 1.0–-22.4) at 1 and 3 months postoperatively compared to 6.3 (IQR 1.7–14.1) and 6.4 (IQR 2.6–-12.1) in age controlled normal eyes (P = 0.94, P = 0.46, respectively). Linear regression analysis showed increasing age as the only variable influencing the percentage decrease in corneal ECD in the study group (P = 0.001). Nanophthalmic eyes with ACD 2.5 mm were significantly better postcataract surgery (P = 0.02 and P = 0.002, respectively). Conclusion: The percentage of ECL in nanophthalmic eyes undergoing phacoemulsification is equivalent to normal eyes. However, in the nanophthamic eyes with AC depth

Purpose: To evaluate the surgical outcomes of repeat trabeculectomy augmented with risk factor adjusted mitomycin C (MMC) exposure in eyes with previous failed trabeculectomy. Methods: Case records of 38 eyes of 37 patients with previous failed filter who underwent repeat trabeculectomy with MMC were reviewed retrospectively. Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP) reduction, requirement of anti-glaucoma medications, postoperative complications, and surgical success (defined as IOP of ≤21 mmHg and >5 mmHg along with 20% reduction from preoperative IOP with or without adjuvant medications) at 1-year postoperatively. Statistical analysis was done using the STATA 14.1 (Texas, USA). Results: Patient's mean age was 46.41 (±20.43) years and the mean preoperative IOP was 32.73 (±9.26) mmHg which reduced to 16.22 (±7.08) mmHg postoperatively at 12 months (P < 0.001). Mean number of anti-glaucoma medications reduced from 2.76 (±0.83) preoperatively to 1.89 (±0.95) postoperatively (P < 0.001). Surgical success was observed in 81.1% at 1 year (n = 30). Eyes that received MMC >3 min had a postoperative mean IOP of 12.50 (±3.23) mmHg compared to 23.08 (±7.19) mmHg with MMC 3 min (P = 0.033). Conclusion: Repeat trabeculectomy with MMC, used in higher concentration and exposure time altered according to individual risk factor plays a crucial role in the success and hence it could be considered as a viable option before planning a tube surgery.

Purpose To compare the outcomes of the Aurolab aqueous drainage implant (AADI) placed in eyes with refractory primary congenital glaucoma (PCG) versus aphakic glaucoma (APG). Design Retrospective comparative interventional case series. Methods Case files of consecutive eyes with PCG or APG that underwent AADI surgery between January 2013 and December 2016 and had a minimum 4 years follow-up were extracted from a computerised database. Failure was defined as intraocular pressure (IOP)>21 mm Hg or reduced<20% below baseline on two consecutive follow-up visits after 3 months, IOP≤5 mm Hg on two consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception. Results Eighty-nine eyes underwent AADI placement, including 42 eyes (47%) with PCG and 47 eyes (53%) with APG. Both groups were comparable at baseline. At 1 year, the APG group had lower mean IOP (13.6±8.1 mm Hg vs 17.6±7.5 mm Hg, p=0.02) with use of fewer IOP-lowering medications (0.8±1.0 vs 1.5±1.0, p=0.01) than the PCG group. The cumulative failure rate at 4 years was 57% (95% CI 43% to 72%) in PCG versus 40% (95% CI 28% to 56%) in the APG eyes (p=0.11). Eyes with PCG had greater tube-related complications (48% vs 38%, p=0.07) and number of reoperations (40% vs 32%, p=0.02) compared with eyes with APG. Conclusions Eyes with APG had relatively better outcomes after AADI placement compared with PCG during 4 years of follow-up. Reoperations accounted for more than 70% of the failures. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the accuracy of four intraocular lens (IOL) prediction formulae (Hoffer Q, Holladay 1, SRK/T and Barrett Universal II) in paediatric cataract. Methods: A prospective study was conducted among all children under 15 years of age, undergoing uncomplicated cataract surgery with in-the-bag IOL implantation at a tertiary care centre. Following detailed evaluation and after obtaining informed consent, the children underwent surgery and the IOL was implanted as per a modification of Wilson and Trivedi recommendation. Prediction error (PE) and absolute prediction error (APE) were computed with each of the formulae, and it was compared across the various subgroups of age (24 mm. The PE of Holladay I (rho = -0.16, P value = 0.044) and Barrett II (rho = -0.16, P value = 0.046) formula was negatively correlated with age, while no correlation was found between PEs of any formula with AL. Conclusion: Barrett II and Hoffer Q formulae appear to provide the most accurate results in the younger age groups, with shorter eyes. Further prospective studies on larger samples of younger children with longer follow-ups are required, to explore the applications of Barrett II formula in the younger age group.