Acuity Chart Research Articles

Prevalence and associated factors of myopia among school students in Shenyang, China: a cross-sectional study.

In recent years, the prevalence of myopia has increased significantly and caused great concern. Nevertheless, an estimate of myopia in the student population in Shenyang, Liaoning Province, China is still lacking. This study aims to determine the prevalence of myopia among students in Shenyang and investigate the associated factors affecting myopia development. Standard logarithmic visual acuity chart and automatic computerized optometry under non-ciliary muscle paralysis were used to test the students' naked visual acuity of their right and left eyes. The included students were organized to fill in questionnaires on WeChat to collect the factors affecting myopia. A total of 34,644 students with a median age of 11.9 years were examined, including 17,563 males and 17,081 females. The overall prevalence of myopia was 60%, with a prevalence of 45% for mild myopia, 13% for moderate myopia, and 1.9% for high myopia. The sex, high educational stage, family history of myopia, doing homework after school or reading and writing for more than 2 h were associated with a higher risk of myopia, while doing eye exercises twice a day or more, going outdoors during recess, reading and writing with eyes more than one foot from books, and sleeping more than 8 h a day were associated factors for preventing myopia. The associated factors influencing myopia vary among different subgroups. The prevalence of myopia in Shenyang is at a high level. In addition to sex, high educational stage and genetic factors, environmental factors including length of eye usage, eye exercises, outdoor activities, eye working distance, and sleep duration are associated with myopia prevalence. Therefore, it is recommended that the occurrence and development of myopia can be prevented by controlling the above environmental factors.

Binocular summation in high and low contrast letter acuities.

Binocular summation, a well-known phenomenon in letter acuity measurement, refers to the improvement in visual performance when viewing with both eyes compared to one eye alone. The present study aims to assess the relationship in binocular summation between high and low contrast letter acuities, and examine whether baseline measure (binocular summation at either high or low contrast) is predictive of the change in binocular summation between contrast conditions. Corrected high and low contrast letter acuities were assessed monocularly and binocularly in 358 normal vision observers aged 18-37 years using Bailey-Lovie charts. All observers had high contrast acuities (both monocular and binocular) of 0.1 LogMAR or better and no known eye disease. Binocular summation was calculated as the difference in LogMAR between the better eye acuity and binocular acuity. We found that binocular summation was present at both contrast levels (0.044 ± 0.002 LogMAR for high and 0.069 ± 0.002 LogMAR for low contrast) with higher magnitude of summation at low contrast, and declined with increasing interocular difference. There was a correlation in binocular summation between high and low contrast. The difference in binocular summation between the two contrast levels was found to be correlated with the baseline measurement. Using common commercially available letter acuity charts, we replicated the findings on binocular acuity summation in normally sighted young adults for both high and low contrast letters. Our study revealed a positive relationship in binocular acuity summation between high and low contrast, and an association between a baseline measure and the change in binocular summation between contrast levels. These findings may serve as a reference in clinical practice and research when high and low contrast binocular summations are measured in assessing binocular functional vision.

Reading performance in Portuguese children from second to tenth grade with the MNREAD reading acuity test

PurposeTo assess reading performance and report normative values for normal sighted Portuguese schoolchildren using the Portuguese version of the MNREAD reading acuity chart. MethodsChildren in the 2nd, 4th, 6th, 8th, and 10th grade in Portugal were recruited for this study. One hundred and sixty-seven children from 7 to 16 years of age participated. The Portuguese version of the printed MNREAD reading acuity chart was used to measure reading performance in these children. The non-linear mixed effects model with negative exponential decay function was used to compute maximum reading speed (MRS) and critical print size (CPS) automatically. Reading acuity (RA) and reading accessibility index (ACC) were computed manually. ResultsThe mean MRS in words-per-minute (wpm) for the 2nd grade was 55 wpm (SD = 11.2 wpm), 104 wpm (SD = 27.9) for the 4th grade, 149 wpm (SD = 22.5) for 6th grade, 172 wpm (SD = 24.6) for 8th grade and 180 wpm for the 10th grade (SD = 16.8). There was a significant difference in MRS between school grades (p < 0.001). Participants’ reading speed increased by 14.5 wpm (95% CL: 13.1–15.9) with each year of increase in age. We found a significant difference between RA and school grades, but not for CPS. ConclusionsThis study provides normative reading performance values for the Portuguese version of the MNREAD chart. The MRS increased with increasing age and school grade, while RA shows initial improvement from early school years and gradually stabilizes in the more mature children. Normative values for the MNREAD test can now be used to determine reading difficulties or slow reading speed in, for example, children with impaired vision.

3-Domains screening toolkit for medical assessment of older drivers: Feasibility study in Australian general practice

Some general practitioners (GPs) find the older driver medical assessment challenging, citing clinical uncertainty and concerns about communicating the need for further testing or driving cessation while maintaining a trusting therapeutic relationship. A screening toolkit could help support GP decision making and communication about fitness to drive. The aim of this study was to investigate the feasibility, acceptability and utility of the 3-Domains screening toolkit for the medical assessment of older drivers in Australian general practice.A prospective mixed-methods study was conducted in nine general practices in south-east Queensland. Participants were older drivers (age ≥75 years) attending annual driving licence medical assessment, GPs and practice nurses. The 3-Domains toolkit comprises three screening tests (Snellen chart visual acuity, functional reach, road signs recognition). We evaluated the feasibility, acceptability and utility of the toolkit.Practices used the toolkit in 43 older driver medical assessments (age 75-93 years; combined predictive score 13-96%). Twenty-two semistructured interviews were conducted. Older drivers felt reassured by the thorough assessment. GPs said the toolkit fitted into practice workflows, informed clinical judgement and supported conversations about fitness to drive while preserving therapeutic relationships.The 3-Domains screening toolkit is feasible, acceptable and useful for the medical assessment of older drivers in Australian general practice.

A cross-sectional study to assess the clinical utility of modern visual function assessments in patients with inherited retinal disease: a mixed methods observational study protocol

BackgroundTreatment options for patients with inherited retinal disease are limited, although research into novel therapies is underway. To ensure the success of future clinical trials, appropriate visual function outcome measures that can assess changes resulting from therapeutic interventions are urgently required. Rod-cone degenerations are the most common type of inherited retinal disease. Visual acuity is a standard measure but is typically preserved until late disease stages, frequently making it an unsuitable visual function marker. Alternative measures are required. This study investigates the clinical utility of a range of carefully selected visual function tests and patient reported outcome measures. The aim is to identify suitable outcome measures for future clinical trials that could be considered for regulatory approval.MethodsThis cross-sectional study involves two participant groups, patients with inherited retinal disease (n = 40) and healthy controls (n = 40). The study has been designed to be flexible and run alongside NHS clinics. The study is split into two parts. Part one includes examining standard visual acuity, low luminance visual acuity, the Moorfields acuity chart visual acuity, mesopic microperimetry and three separate patient reported outcome measures. Part two involves 20 min of dark adaptation followed by two-colour scotopic microperimetry. Repeat testing will be undertaken where possible to enable repeatability analyses. A subset of patients with inherited retinal disease will be invited to participate in a semi-structured interview to gain awareness of participants’ thoughts and feelings around the study and different study tests.DiscussionThe study highlights a need for reliable and sensitive validated visual function measures that can be used in future clinical trials. This work will build on work from other studies and be used to inform an outcome measure framework for rod-cone degenerations. The study is in keeping with the United Kingdom Department of Health and Social Care research initiatives and strategies for increasing research opportunities for NHS patients as part of their NHS care.Trial registrationISRCTN registry, ISRCTN24016133, Visual Function in Retinal Degeneration, registered on 18th August 2022.

Evaluation of Visual Skills Between Cricket Players and Sedentary Individuals

Aim: This study aims to evaluate the visual skills between cricket players and sedentary individuals of the same age group and to determine that visual skills are beneficial for both competitive sports performance and daily task activities. Settings and Design: It was a sports vision-based comparative study conducted in the outpatient department of ophthalmology for preliminary ocular examination as well as in the cricket ground for sports vision-based tests. Methods and materials: This study carries 200 subjects out of which 100 cricket players and 100 sedentary individuals (i.e individuals who are not involved in any sports activities) participated between the age group of 18 to 26. Participants underwent preliminary ocular examinations in which all those ocular diseases and binocular vision anomalies are excluded. All subjects were undergone the following sports vision test: stereopsis was measured by Randot stereo acuity chart, accommodative facility with +/- 2.00 flippers, saccadic eye movement was measured by Lang fixation stick and eye-hand coordination was recorded by Alternate hand wall toss test. Result: The cricket players exhibited better accommodative facility (p=0.05) saccadic eye movements (p=0.03) and better eye-hand coordination (p=0.01) stereopsis was good in sedentary individuals (p=0.06) confirming that basic visual skills were high in sedentary individuals. Conclusion: These findings evidence that cricket players exhibit better performance in more visual skills in comparison with a group of individuals without sporting background, suggesting an improvement in visual skills due to routine systematic activity in sports as well as daily tasks.

Incidence and clinical profile of Marcus Gunn jaw-winking phenomenon in congenital ptosis at a tertiary eye hospital in western Uttar Pradesh, India

Objectives: The objectives of this study were to report the hospital-based incidence and a rare case series of Marcus Gunn jaw-winking phenomenon (MGJWP) in patients with congenital ptosis Material and Methods: This was a retrospective non-interventional case series. The medical records of all patients diagnosed with MGJWP over the past 3.5 years were retrieved from the electronic medical record. Patients with documented evidence of the presence of ptosis with MGJWP were included and analyzed for visual acuity, the presence of squint and amblyopia, and the presence of other aberrant regenerations. Results: A total of 198 patients were diagnosed with congenital ptosis, out of which 23 (11.6%) patients had MGJWP along with congenital ptosis and 175 (84.4%) patients have congenital ptosis without MGJWP. There were 12 males and 11 females. The mean age at presentation was 10.35 ± 8.4 years (range from 2 to 28 years). All the patients presented unilateral MGJWP. The right eye was involved in seven patients (30.4%) and the left eye in 16 patients (69.5%). Most of the patients had observed the onset of MGJWP by parents since birth. Visual acuity was measured by Snellen’s distance acuity chart in 15 patients. Eight patients were preverbal, and their vision was assessed by the fixation pattern, which was central, steady, and maintained. Nine patients (39.1%) were emmetropic, seven patients (30.4%) had astigmatism, and seven patients were amblyopic in the affected eye. Strabismus was noted in nine patients (39.1%) in this study. Monocular elevation deficiency was noted in five patients, three patients have exotropia, and one had hypotropia. Conclusion: All the patients had a mild form of MGJWP with no intervention required in any of the cases. The hospital-based incidence of MGJWP in congenital ptosis is 11.6%. Most of the patients had observed the onset of MGJWP by their parents since birth.

Development and validation of the first Canadian Aboriginal syllabics visual acuity chart

ObjectiveTo design and validate the first visual acuity (VA) chart in the Canadian Aboriginal syllabics (CAS) alphabet. DesignProspective, nonrandomized, within-subjects cross-sectional study. ParticipantsTwenty Latin- and CAS-reading subjects were recruited from Ullivik, a residence in Montreal for Inuit patients. MethodsVA charts were made in Latin and in CAS using letters conserved across Inuktitut, Cree, and Ojibwe languages. Fonts were similar in style and size between charts. Each chart was made for a viewing distance of 3 m, with 11 lines of VAs from 20/200 to 20/10. Charts were created using LaTeX to ensure proper formatting and optotype sizing and displayed to scale on an iPad Pro. Each participant had his or her best-corrected VA for each eye measured using the Latin and CAS charts sequentially for a total of 40 eyes. ResultsMedian best-corrected VAs were 0.04 logMAR (range, –0.06–0.54) and 0.07 logMAR (range, 0–0.54) for the Latin and CAS charts, respectively. Median difference between CAS and Latin charts was 0 logMAR (range, –0.08–0.1). Mean ± SD difference between charts was 0.01 ± 0.03 logMAR. Pearson's r correlation between groups was 0.97. The two-tailed paired t test between groups was p = 0.26. ConclusionsWe demonstrate here the first VA chart in Canadian Aboriginal syllabics for Inuktitut-, Ojibwe-, and Cree-reading patients. The CAS VA chart has highly similar measurements to the standard Snellen chart. Testing VA for Indigenous patients in their native alphabet may provide patient-centred care and accurate VA measurements for Indigenous Canadians.

A CLINICAL STUDY ON KERATOMYCOSIS IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL

AIM : To study etiology , epidemiological factors leading to keratomycosis in various subgroups of population like different age and sex groups. To determine spectrum of ocular manifestations in patients with keratomycosis. METHODS : This is a prospective study done in 100 patients of fungal keratitis over a period of 1 year with proper recordings of snellens visual acuity chart, slit lamp biomicroscopy, direct and indirect ophthalmoscopy, conrmed by culture, histology and confocal microscopy, PCR, in patients attending tertiary care hospital , kakinada. This study was conducted in 100 pati RESULTS : ents , of most common age group was 31-40 years i.e, which most exposed to trauma to cornea with vegetative matter, immunocompromised people, over usage of steroids and antibiotics and many factors. Males are more affected and among agricultural workers with mostly unilateral in presentation. Majority presented with pain, redness , foreign body sensations, defective vision. Ulcer is dirty looking, feathery margins with wessely ring and satellite lesions. CONCLUSION: Fungal infections of cornea continue to be an important cause of ocular morbidity, particularly in the communities of agriculture of developing countries. A proper understanding of agent and host factors involved in these infections will improve the outcome of this condition.

A CLINICAL STUDY ON DIABETIC RETINOPATHY IN DIABETES MELLITUS PATIENTS ATTENDING TERTIARY CARE HOSPITAL

AIM : To study manifestations of Diabetic retinopathy in various subgroups of population like different age and sex groups of Diabetes mellitus patients.To determine manifestations of diabetic retinopathy in Diabetic patients METHODS : This is a prospective study done in 100 patients of Diabetic mellitus over a period of one year with proper recordings of snellens visual acuity chart, slit lamp biomicroscopy, direct and indirect ophthalmoscopy,laboratory investigations in patients attending tertiary care hospital, kakinada. This study was conducted in 100 patients ,of most common age group RESULTS : was 41-50 yearss,40% of the patients were with poor glycemic control with longer duration of Diabetes mellitus. Males are more affected than females. Majority presented with blurring of vision,watering from eyes. Diabetic retinopathy is a vision threatening condition,it CONCLUSION: can be diagnosed at the time of diagnosis of diabetes mellitus.Thus vision loss due to diabetic retinopathy is preventable through strict glycemic control and frequent funduscopic examination by an ophthalmologist.Primary treatment helps to alleviate the visual acuity and prevent further loss.

Association between vision and cognitive function among community-dwelling older adults in Selangor, Malaysia.

To determine the association between distance and near visual acuity (VA) and cognitive function among older adults in Selangor, Malaysia. A total of 230 older adults (age ≥60y) participated in this study. Habitual distance and near VA were measured using the Early Treatment Diabetic Retinopathy Study Chart and Lighthouse Near Visual Acuity Chart, respectively. Global cognitive function was assessed using the Mini-Mental State Examination (M-MSE) and the Malay language version of the Montreal Cognitive Assessment (M-MoCA). Digit Symbol (DS) subtest was used to measure information processing. No significant association was observed between vision and M-MSE and M-MoCA scores. However, poor distance and near VA were found to be significantly associated with low DS scores [distance VA: β=-0.01, R 2=0.1, P=0.02; odds ratio (OR)=2.84, 95% confidence interval (CI), 1.10-7.33, P=0.03; near VA: β=-0.05, R 2=0.08, P=0.00; OR=3.32, 95%CI, 1.28-8.59, P=0.01]. Poor vision is associated with a decline in information processing in older adults and substantiates the importance of preserving good vision in maintaining cognitive function.

Visual acuity charts in the Russian Empire, the USSR and modern Russia

Visual acuity is the quantitative parameter of the visual system characterizing its functional spatial resolution. Special test charts are commonly used for visual acuity assessment. The development of foreign tests for visual acuity is comprehensively covered in the literature, while the history of improving visual acuity charts in modern Russia, the USSR, and in the territory of the Russian Empire is only considered fragmentarily. In particular, there are almost no mentions of D.A. Sivtsev's work on proper letter-signs selection, and of A.A. Kryukov's tests. The purpose of this article is to review the history of developing visual acuity assessment methods in the Russian Empire, the USSR and modern Russia. One of the first sets of tests for visual acuity assessment available in the Russian Empire was developed by A.A. Kryukov; it was republished several times, but some criticism of the test can be encountered in the literature of that period. Subsequently, a task of developing a more accurate method was presented, which was implemented in the form of several editions of the visual acuity charts by D.A. Sivtsev and S.S. Golovin. The authors put a lot of effort into selecting the letters for the most reliable results of visual acuity assessment, excluded some unsuccessful characters (Cyrillic letters 'Ж' and 'Ю') and changed the size levels of the chart (the lines corresponding to the visual acuity levels of 1.25 and 1.5 were substituted by 1.5 and 2.0). Around the same period, A. Holina's chart appeared in print, but due to its poor structure the chart did not gain popularity, although it had a number of advantages. The review also considers some modern tests: the RORBA chart (named after the authors Rosenbaum, Ovechkin, Roslyakov, Bershanskiy, Aizenshtat), the vanishing optotypes by S.A. Koskin et al., the three-bar optotypes by the Institute for Information Transmission Problems (IITP), and the "Quartet" optotypes. Despite a large number of options, the search for the best method of measuring visual acuity for various medical and scientific tasks continues.

Endothelial Cell Count and Central Corneal Thickness In Type-2 Diabetes

Objectives: This study aimed at evaluating and comparing the values of Endothelial Cell Density (ECD) and Central Corneal Thickness (CCT) among Type 2 Diabetic cases and Non-Diabetics. It also aimed at finding the correlation between ECD and CCT with the diabetes duration, Random Blood Sugar (RBS) levels, and more severe stages of Diabetic Retinopathy (DR) in the diabetic subjects. Design: Comparative Cross-sectional. Study Setting and Duration: The data was collected from the General Outdoor Patient Department (OPD) of Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan within duration of 8 months from January to August 2021. Methodology: After taking the informed consent, a complete history of each subject was taken. ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity chart was used to evaluate Visual acuity and subjective refraction and then a complete slit-lamp anterior and posterior segment examination was performed followed by Specular Microscopy to measure the ECD and CCT. The diabetic subjects were checked for their RBS immediately after Specular Microscopy (TOMEY Specular Microscope EM-4000) using a digital glucometer and the readings were carefully recorded. Results: Results showed ECD to be significantly lower (p = 0.000) while CCT to be significantly higher (p = 0.000) in type-2 Diabetics than in Non-Diabetics. On correlation analysis, ECD was negatively correlated (p&lt;0.05) while CCT was positively correlated (p&lt;0.05) with diabetes duration, RBS, and severity of DR. Conclusion: This study concluded that the ECD and CCT were significantly different among diabetics and non-diabetics.

Outcome of tuberculous meningitis in children aged 9 months to 12 years at the end of intensive phase of treatment

BackgroundTuberculous meningitis (TBM) is associated with high morbidity and mortality. Most of the literature focuses on outcomes at the end of therapy when it may be too late for intervention to improve the outcomes. So, the present study addresses outcomes by the end of intensive course of therapy. MethodsIt was a prospective cohort observational study that enrolled 80 patients with TBM between 9 months and 12 years of age. Participants were classified into Definite, Probable and Possible TBM using Marais criteria. Survival/Mortality was evaluated at the end of hospital stay. Demographic, clinical, cerebrospinal fluid and radiological parameters were evaluated for predictors of morbidity and mortality. Standardized tools were used to assess possible impairments in different domains at the end of intensive phase of treatment, namely Gross Motor Functional Classification System for motor functional ability, Pediatric-Mini Mental score examination (MMSE), Blantyre Coma Scale (BCS) score and Vineland Social Maturity Scale (VSMS) for cognitive outcome, Auditory Brainstem Evoked Responses for hearing outcome and using Teller's/Snellen's visual acuity charts to assess visual impairment. ResultsA high Mortality rate of 42.5% was seen in the enrolled patients. Out of the total 80 patients, 20% recovered completely while 36.25% survived with disability (morbidity). Motor, Hearing, Cognitive and Vision impairment was present in 33.3%, 4%, 33.3% and 48.9% of the survivors respectively. On multivariate regression, raised intracranial tension and stage III disease were significantly associated with mortality. Morbidity was significantly associated with Stage III disease on multivariate analysis. ConclusionsDespite advances in treatment, Tuberculous meningitis is associated with high burden of deaths and devastating neurological sequelae. Timely diagnosis and intervention of neurological impairments is needed to improve the outcome of TBM in survivors.

Comparison of Retinal Nerve Fiber Layer Thickness in Diabetic Patients with and without Diabetic Retinopathy and Healthy Individuals using Ocular Coherence Tomography

Objectives: Using Ocular Coherence Tomography, the study aimed to examine the RNFL thickness of type diabetics, patients with Diabetic Retinopathy, and healthy persons. Methods: 101 patients from the outside patient department and the Retina department of Tertiary Eye Care Hospital participated in this research. The cross-sectional study design was used. Non-probability consecutive sampling was utilized as the sampling technique. Patients were selected according to inclusion criteria. Visual Acuity was assessed using an (ETDRS) Early Treatment Diabetic Retinopathy Study Visual acuity chart at a distance of 6m. After the Ophthalmological Examination was done by a doctor, Ocular Coherence Tomography (Heidelberg Spectralis) was performed to assess RNFL thickness. The association between different types of diabetic retinopathy, Type-2 Diabetes, Normal Healthy, and retinal RNFL thickness was determined using a one-way ANOVA test. Results: The age range of the participants was between 40 and 69 years, with a mean of 55.68 ±10.437 years. 15.3% had diabetes for 1 to 5 years. 24% had Diabetes for 6 to 10 yea 19.9% had a Diabetes duration of 19.9%. The RNFL thickness was significantly decreased in type 2 diabetics, NPDR, and PDR as compared to normal Healthy individuals (p&lt;.001). Age and duration of diabetes were closely correlated with the retinal nerve fiber layer (p&lt;0.001). Conclusion: This study indicated that the (retinal nerve fiber layer) RNFL was considerably thinner in all quadrants of diabetic retinopathy (NPDR, PDR), type 2 diabetics, and healthy persons. Age and duration of diabetes were significantly correlated with average RNFL thickness.

Prevalence and causes of low vision in a population-based study on childhood visual impairment in North India (CHVI 4).

The present study was a population-based study to determine the prevalence and causes of low vision in children less than 16 years in North India. This cross-sectional study was conducted in 40 clusters of urban Delhi. Children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. All children with visual acuity of <6/12 in any eye in the age group between 3 and 15 years and inability to follow the light in age less than 3 years were referred for detailed ophthalmic examination in a centrally based clinic. Cycloplegic examination and best-corrected visual acuity (BCVA) were assessed. They were examined by an ophthalmologist to determine the prevalence and causes of functional low vision (FLV). The prevalence of FLV was compared with other population-based studies across India and other parts of the world. Amongst 20,955 children examined for visual acuity, 789 children were referred to the central clinic for detailed ophthalmic examination. The overall prevalence of low vision was 0.62 per 1,000 children (95% confidence interval [CI] 0.12-1.90). The main anatomical cause of low vision was retinal abnormalities. Although the prevalence of children with low vision decreased as compared to previous population-based studies. There is an important need to create awareness among parents on appropriate and timely usage of low-vision devices (LVDs) at an affordable cost to improve the visual quality in children with low vision.

ESTIMATION OF VISUAL OUTCOME, COMPLICATIONS AFTER ND – YAG CAPSULOTOMY

Aims And Objectives:To analyse the clinical outcomes of Nd: YAG laser posterior capsulotomy. It is a cross sectional prospective interventional study. 1. To assess the visual outcome following posterior capsulotomy with Nd: YAG laser for posterior capsular opacication. 2. To study Intraocular pressure (IOP) changes after posterior capsulotomy with Nd: YAG laser. 3.To study other post -procedural Nd: YAG laser capsulotomy complications. Materials And Methods: A Cross-sectional prospective interventional study was conducted in the Department of Ophthalmology, Rangaraya medical college, Kakinada on 75 patients over the age of 16 who had clinically detected posterior capsule opacication following cataract extraction. Study tools: Snellen's visual acuity chart, Slit lamp biomicroscope, Direct ophthalmoscope, Indirect ophthalmoscope- +90D biomicroscope, Schiotz / Applanation tonometer Results Signicant visual improvement was seen in 96% patients. Conclusion: The results of the present study show that posterior capsulatomy with a Nd: YAG Laser is effective and safe method to improve vision.

Efficacy and Safety of Suprachoroidal Administration of Triamcinolone Acetonide in Patients of Refractory Diabetic Macular Edema

Background: To determine the efficacy and safety of suprachoroidal administration of triamcinolone acetonide in patients of refractory diabetic macular edema. Study setting: This study was conducted from September 2020 to April 2021 in the department of Ophthalmology FMU/Allied Hospital Faialabad. Study design was quasi experimental Materials and methods: sample size was 45, through non probability consecutive sampling. All 45 patients with refractory diabetic macular edema were enrolled and following parameters e.g Best corrected visual acuity (less than 20/40 on Snellen Visual acuity Chart),IOP &lt; 21 mm of Hg, Central macular thickness &gt;300 micrometers, were recorded as baseline at the start of study. Suprachoroidal triamcinolone acetonide injection 0.1 ml given to these 45 patients. Same parameters e.g Best Corrected visual acuity, Intraocular pressure, Central Macular Thickness were measured at each follow-up visit. First follow-up visit was conducted on next day then one week , one month and in third month. Results: In this study, mean of age was 50.71 ± 7.05 years. 23(51.1%) were males and 22(48.9%) were females. Pre-treatment Intra ocular pressure, best corrected visual acuity and macular thickness were 13.4± 1.9 mmHg ,0.72± 0.11 and 638.04 ± 133.9 micrometers respectively. After one-month Intra ocular pressure, Best corrected visual acuity and Central macular thickness were 13.71 ± 2.61 mmHg, 0.48± 0.11 and 314.11 ±53.8 micrometer and after three months 13.24±1.26mmHg, 0.46±0.12 and 306.9±49.52 micrometer respectively. Statistical significant difference was found for pre and post Best corrected visual acuity and Central macular thickness (p-value &lt;0.0001).In two (4.4%) patients, intra ocular pressure was raised. Practical implication: This study was highlighted safety and efficacy of suprachoroidal injection of triamcinolone acetonide in cases of refractory diabetic macular edema Conclusion: Suprachoroidal Triamcinolone acetonide injection is proved to be safe and effective treatment modality for the patients of refractory diabetic macular edema as it decreases central macular thickness and improves best corrected visual acuity. Keywords: Diabetic macular edema, Suprachoroidal, Triamcinolone acetonide, Intra ocular pressure, Optical coherence tomography, visual acuity.

Effects of Hydroxychloroquine on Progression of Diabetic Retinopathy in Subjects with Rheumatoid Arthritis and Type 2 Diabetes Mellitus.

The study was conducted to investigate the effects of hydroxychloroquine, an anti-inflammatory drug, which was recently approved and used as an add on oral antidiabetic drug for uncontrolled Type 2 Diabetes Mellitus (DM) on an adequate dose of sulfonylurea and metformin on the progression of diabetic retinopathy (DR) in subjects with Rheumatoid Arthritis and Type 2 Diabetes Mellitus. The primary objective was to evaluate the effect of hydroxychloroquine on the onset of Diabetic Retinopathy (DR) and progression of the disease. Best-corrected visual acuity (BCVA) charts with 3 or more lines worsening of visual acuity and the development of clinically significant macular edema (CSME) were added as secondary objectives as described in the Early Treatment Diabetic Retinopathy Study (ETDRS). This retrospective analysis was done from medical records of all Rheumatoid Arthritis (RA) patients who also had T2DM and were treated with hydroxychloroquine (HCQ) 400 mg OD or 200 mg BID (N=65) and received ophthalmologic care at an endocrinology clinic in India up to a mean follow-up of 3.5±0.5 years and matched subjects taking any other disease-modifying antirheumatic drugs (DMARD) and pioglitazone (N=34). Baseline characteristics were similar in both the groups, with matched glycated haemoglobin (9.1 % and 9.2 % respectively, p=0.127). In both groups, over 3.5 years, HbA1c was reduced significantly. No new cases of DR were detected in the HCQ group, whereas 2 patients had developed DR in the pioglitazone group. At the base line visit, mild non-proliferative Diabetic Retinopathy (NPDR) was present in 18 eyes and 14 eyes in the HCQ and pioglitazone groups, respectively. Progression to moderate NPDR over 3.5 years occurred in 2 out of 18 (11 %) eyes in the HCQ group and 8 out of 14 (57 %) eyes in the pioglitazone group, respectively, representing a significant relative risk reduction (p=.001). No patients had progressed from mild NPDR to severe NPDR in the HCQ group, whereas 2 eyes had progressed from mild NPDR to severe NPDR in the pioglitazone group. None of the patients in either arm developed diabetic macular oedema. Progression of DR from mild to moderate NPDR or severe NPDR may be delayed by HCQ. Large scale randomised prospective clinical trial is required to establish the risk-benefit profiles of HCQ in T2DM.ct.

The Philippine Peso Bill as an Alternative Near Visual Acuity Chart in Filipino Eyes: A Pilot Study.

PurposeThis study aimed to determine if near visual acuity measurements using a Philippine peso bill are comparable to a standard Jaeger chart.Study DesignThis is a cross-sectional study comparing the near visual acuity measurements of a Philippine peso bill and a Jaeger chart among sixty subjects.MethodsLogMAR scores from the two methods were analyzed using Wilcoxon Mann–Whitney test. The relationship of the logMAR scores between these methods was determined using Spearman rank order correlation. The Bland-Altman plot was used to determine the comparability between quantitative measurements for near visual acuity using the standard Jaeger chart (reference) and the Philippine peso bill.ResultsThere were no significant differences in the proportion of Jaeger scores and mean logMAR equivalents between the two methods (p > 0.05). The scatter plot diagram shows a positive upward trend with a very strong and significant correlation between logMAR scores of Jaeger chart and Philippine peso bill methods (r = 0.9258, p < 0.0001). With a concordance correlation coefficient of 0.9505, there is a high agreement between these two measures. The Philippine peso bill overestimates the Jaeger chart visual acuity by 0.04 logMAR units. We suspect that the contrast between the background color and the serial numbers of the peso bill may have brought about this outcome.ConclusionThe Philippine peso bill may be used as an alternative measuring tool for near visual acuity. However, there is a tendency to overestimate the scores obtained using the Philippine peso bill. Future studies are recommended to validate the results in a tele-ophthalmology setting.