Comprehensive Eye Examination Research Articles

Cross-sectional study of prevalence and correlates of fear of falling in the older people in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

ObjectiveTo report the prevalence and risk factors for the fear of falling (FOF) among older individuals living in residential care facilities in India.DesignCross-sectional study.SettingHomes for the aged centres in Hyderabad,...

Prevalence of visual impairment and estimation of refractive errors among school children in Kakamega, Kenya.

To investigate the prevalence of visual impairment (VI) and provide an estimation of uncorrected refractive errors in school-aged children, conducted by optometry students as a community service. The study was cross-sectional. Totally 3343 participants were included in the study. The initial examination involved assessing the uncorrected distance visual acuity (UDVA) and visual acuity (VA) while using a +2.00 D lens. The inclusion criteria for a subsequent comprehensive cycloplegic eye examination, performed by an optometrist, were as follows: a UDVA<0.6 decimal (0.20 logMAR) and/or a VA with +2.00 D ≥0.8 decimal (0.96 logMAR). The sample had a mean age of 10.92±2.13y (range 4 to 17y), and 51.3% of the children were female (n=1715). The majority of the children (89.7%) fell within the age range of 8 to 14y. Among the ethnic groups, the highest representation was from the Luhya group (60.6%) followed by Luo (20.4%). Mean logMAR UDVA choosing the best eye for each student was 0.29±0.17 (range 1.70 to 0.22). Out of the total, 246 participants (7.4%) had a full eye examination. The estimated prevalence of myopia (defined as spherical equivalent ≤-0.5 D) was found to be 1.45% of the total sample. While around 0.18% of the total sample had hyperopia value exceeding +1.75 D. Refractive astigmatism (cil<-0.75 D) was found in 0.21% (7/3343) of the children. The VI prevalence was 1.26% of the total sample. Among our cases of VI, 76.2% could be attributed to uncorrected refractive error. Amblyopia was detected in 0.66% (22/3343) of the screened children. There was no statistically significant correlation observed between age or gender and refractive values. The primary cause of VI is determined to be uncorrected refractive errors, with myopia being the most prevalent refractive error observed. These findings underscore the significance of early identification and correction of refractive errors in school-aged children as a means to alleviate the impact of VI.

The Association of Urinary Sodium Excretion with Glaucoma and Related Traits in a Large United Kingdom Population

Excessive dietary sodium intake has known adverse effects on intravascular fluid volume and systemic blood pressure, which may influence intraocular pressure (IOP) and glaucoma risk. This study aimed to assess the association of urinary sodium excretion, a biomarker of dietary intake, with glaucoma and related traits, and to determine whether this relationship is modified by genetic susceptibility to disease. Cross-sectional observational and gene-environment interaction analyses in the population-based UK Biobank study. Up to 103 634 individuals (mean age 57 years, 51% women) with complete urinary, ocular, and covariable data. Urine sodium:creatinine ratio (UNa:Cr; mmol:mmol) was calculated from a midstream urine sample. Ocular parameters were measured as part of a comprehensive eye examination and glaucoma case ascertainment was through a combination of self-report and linked national hospital records. Genetic susceptibility to glaucoma was calculated based on a glaucoma polygenic risk score (PRS) comprising 2 673 common genetic variants. Multivariable linear and logistic regression, adjusted for key sociodemographic, medical, anthropometric, and lifestyle factors, were used to model associations and gene-environment interactions. Corneal-compensated IOP, optical coherence tomography derived macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness, and prevalent glaucoma. In maximally adjusted regression models, a one standard deviation increase in UNa:Cr was associated with higher IOP (0.14mmHg; 95% CI, 0.12 to 0.17; P<0.001) and greater prevalence of glaucoma (OR, 1.11; 95% CI, 1.07 to 1.14; P<0.001), but not mRNFL or GCIPL thickness. Compared to those with UNa:Cr in the lowest quintile, those in the highest quintile had significantly higher IOP (0.45mmHg; 95% CI, 0.36 to 0.53, P<0.001) and prevalence of glaucoma (OR, 1.30; 95% CI, 1.17 to 1.45; P<0.001). Stronger associations with glaucoma (P interaction=0.001) were noted in participants with a higher glaucoma PRS. Urinary sodium excretion, a biomarker of dietary intake, may represent an important modifiable risk factor for glaucoma, especially in individuals at high underlying genetic risk. These findings warrant further investigation as they may have important clinical and public health implications.

Ocular manifestations of severe familial hypercholesterolemia

BackgroundTo study ocular manifestations of patients with severe familial hypercholesterolemia (FH). MethodsIn this population-based case-control study, patients suffering from severe familial hypercholesterolemia from the Lebanese Familial Hypercholesterolemia Registry, along with age and gender-matched healthy controls were recruited. All participants underwent a comprehensive eye examination, and patients underwent fluorescein angiography as well. Logistic regression models were used to identify any association between patients with severe familial hypercholesterolemia and abnormal eye findings, while adjusting for hypertension and pack-year smoking. The main outcome measure of this study was the development of ocular vascular abnormalities. Results28 patients and 28 controls were recruited. Patients with severe familial hypercholesterolemia had significantly greater odds of developing corneal arcus and xanthelasmas than the control group (p < 0.001). Retinal vascular abnormalities (plaques) were exclusively and more significantly present in patients with familial hypercholesterolemia (18 %). Similarly, retinal arteriosclerosis was exclusively and significantly more prevalent in the familial hypercholesterolemia group (p < 0.001, adjusted odds ratio 6.8). Stratification by LDL levels and genotypes did not show any significant change in the prevalence of any ocular finding. ConclusionIn addition to the well-established increase in incidence of corneal arcus and xanthelasmas, severe familial hypercholesterolemia patients have more prevalent retinal vascular abnormalities that include vascular plaques and arteriosclerosis.

Exploring Pediatric Vision Care: Insights from Five Years of Referral Cases in the UCI Eye Mobile and Implications of COVID-19.

To analyze referral rates, patient demographics, referral indications, and the impact of socioeconomic factors on ocular health from the University of California Irvine (UCI) Eye Mobile for Children, particularly during the coronavirus disease 2019 (COVID-19) pandemic. A retrospective chart review was performed on de-identified records of children examined on the UCI Eye Mobile. GraphPad Prism 10.0.0 and Python software were used for statistical analyses. In the academic years from 2018 to 2022, 3,619 children received comprehensive eye examinations on the UCI Eye Mobile. Among them, 76 were referred to a pediatric ophthalmologist. The majority of these children were Hispanic (72.6%, 54 of 74), followed by Asian (10.9%, 8 of 74). A significant proportion (82.9%, 63 of 76) attended school districts with median incomes below that of Orange County. Statistically significant differences were found in age (P = .001; pre-COVID: 3.98 ± 1.08 years vs COVID: 5.75 ± 2.92 years) and gender (P = .023; pre-COVID female: 31 of 41 vs COVID female: 15 of 32) between the pre-COVID and COVID years. Additionally, there were significant differences in the proportion of children with hyperopia with astigmatism between the pre-COVID and COVID years (P = .044; pre-COVID: 23 of 40 vs COVID: 12 of 35). The most common indications for ophthalmologist referrals were for strabismus evaluation/treatment (28.9%, 22 of 76), followed by abnormal cup-to-disc ratio (21.1%, 16 of 76). The study highlights the pivotal role of the UCI Eye Mobile for children in identifying ocular conditions needing referrals to subspecialty care. The majority of children needing these referrals attended schools in lower economic communities. Additionally, the COVID-19 pandemic appears to have influenced the demographic and clinical characteristics. [J Pediatr Ophthalmol Strabismus. 20XX:X(X):XXX-XXX.].

Development and evaluation of Order of Magnitude (OM): a virtual reality-based visual field analyzer for glaucoma detection.

This study introduces the Order of Magnitude (OM), a cost-effective, indigenous, virtual reality-based visual field analyzer designed for detecting glaucomatous visual field loss. The OM test employs a two-step supra-thresholding algorithm utilizing stimuli of 0.43°diameter (equivalent to Goldmann size III) at low and high thresholds. A comparative analysis was conducted against the Humphrey visual field (HVF) test, considered the gold standard in clinical practice. Participants, including those with glaucoma and normal individuals, underwent comprehensive eye examinations alongside the OM and HVF tests between April and October 2019. Diagnostic sensitivity and specificity of the OM test were assessed against clinical diagnoses made by specialists. We studied 157 eyes (74 glaucomatous, 83 control) of 152 participants. Results demonstrated a high level of reliability for both OM and HVF tests, with no significant difference observed (P = 0.19, Chi-square test). The sensitivity and specificity of the OM test were found to be 93% (95% CI 86-100%) and 83% (95% CI 72.4-93%), respectively, while the HVF test showed sensitivity and specificity of 98% (95% CI 93.9-100%) and 83% (95% CI 73.9-92.8%), respectively. These findings suggest that the OM test is non-inferior to the reference standard HVF test in identifying glaucomatous visual field loss.

Tessellated fundus occurs earlier than myopia in children aged 3-6 years.

Tessellated fundus can exist in normal healthy eyes. This study aims to evaluate the occurrence and influencing factors of tessellated fundus in preschool children aged 3-6 years. This kindergarten-based cross-sectional study included 1716 children with an age range of 3-6 years. All participants underwent a comprehensive eye examination and a questionnaire. According to the number of quadrants occupied by tessellated fundus around the optic disc in fundus photographs, it was divided into four grades. 600 (35.0%) children had peripapillary tessellation. According to the spherical equivalent (SE), the subjects were divided into three groups: Hyperopia group (SE > + 0.75D, n = 1194)；Pre-myopia group (-0.50D < SE ≤ + 0.75D, n = 455); Myopia group (SE ≤ -0.50D, n = 67). The proportion of peripapillary tessellated fundus was 33.0%, 38.0%, 50.7% respectively. According to the regression analysis, in the non-myopia group (Pre-myopia group and Hyperopia group), the occurrence of peripapillary tessellated fundus was associated with longer axial length (OR, 1.566; 95% CI: 1.229-1.996, p < 0.001) and larger corneal radius of curvature (OR, 1.837; 95% CI: 1.006-3.354, p = 0.048). However, in Pre-myopia group, the corneal radius of curvature was not associated with the occurrence of peripapillary tessellated fundus (p = 0.830). In Hyperopia group, the corneal radius of curvature was associated with the occurrence of peripapillary tessellated fundus (OR, 2.438; 95% CI: 1.160-5.122, p = 0.019). The occurrence of peripapillary tessellated fundus is more than 30% in 3-6 year old preschool children. Tessellated fundus can also occur in non-myopic children, and is related to the length of axial length and large radius of corneal curvature.

Performance of anterior segment OCT-based algorithms in the opportunistic screening for primary angle-closure disease

PurposeThis study aimed to investigate the performance of deep learning algorithms in the opportunistic screening for primary angle-closure disease (PACD) using combined anterior segment parameters. MethodsThis was an observational, cross-sectional hospital-based study. Patients with PACD and healthy controls who underwent comprehensive eye examinations, including gonioscopy and anterior segment optical coherence tomography (ASOCT) examinations under both light and dark conditions, were consecutively enrolled from the Department of Ophthalmology at the Beijing Tongren Hospital between November 2020 and June 2022. The anterior chamber, anterior chamber angle, iris, and lens parameters were assessed using ASOCT. To build the prediction models, backward logistic regression was utilized to select the variables to discriminate patients with PACD from normal participants, and the area under the receiver operating characteristic curve was used to evaluate the efficacy of the opportunistic screening. ResultsThe data from 199 patients (199 eyes) were included in the final analysis and divided into two groups: PACD (109 eyes) and controls (90 eyes). Angle opening distance at 500 μm, anterior chamber area, and iris curvature measured in the light condition were included in the final prediction models. The area under the receiver operating characteristic curve was 0.968, with a sensitivity of 91.74 % and a specificity of 91.11 %. ConclusionASOCT-based algorithms showed excellent diagnostic performance in the opportunistic screening for PACD. These results provide a promising basis for future research on the development of an angle-closure probability scoring system for PACD screening.

Novel MIP gene mutation causes autosomal-dominant congenital cataract.

To identify disease-causative mutations in families with congenital cataract. Two Chinese families with autosomal-dominant congenital cataract (ADCC) were recruited and underwent comprehensive eye examinations. Gene panel next-generation sequencing of common pathogenic genes of congenital cataract was performed in the proband of each family. Sanger sequencing was used to valid the candidate gene mutations and sequence the other family members for co-segregation analysis. The effect of sequence changes on protein structure and function was predicted through bioinformatics analysis. Major intrinsic protein (MIP)-wildtype and MIP-G29R plasmids were constructed and microinjected into zebrafish single-cell stage embryos. Zebrafish embryonic lens phenotypes were screened using confocal microscopy. A novel heterozygous mutation (c.85G>A; p.G29R) in the MIP gene was identified in the proband of one family. A known heterozygous mutation (c.97C>T; p.R33C; rs864309693) in MIP was found in the proband of another family. In-silico prediction indicated that the novel mutation might affect the MIP protein function. Zebrafish embryonic lens was uniformly transparent in both wild-type PCS2+MIP and mutant PCS2+MIP. Two missense mutations in the MIP gene in Chinese cataract families are identified, and one of which is novel. These findings expand the genetic spectrum of MIP mutations associated with cataracts. The functional studies suggest that the novel MIP mutation might not be a gain-of-function but a loss-of-function mutation.

Mean Amplitude of Diurnal Variation of Sub-Foveal Choroidal Thickness among Adults with Healthy Eyes Visiting Outpatient Department of a Tertiary Eye Care Centre.

The choroid, particularly the choroidal vasculature, plays an important role in the pathophysiology of various ocular diseases. Diurnal variation in the thickness of the choroid has been reported in previous studies. This study aimed to find the mean amplitude of diurnal variation of sub-foveal choroidal thickness among adults with healthy eyes visiting the outpatient Department of a tertiary eye care centre. A descriptive cross-sectional study was conducted among adults with healthy eyes presenting to the outpatient Department of a tertiary eye care centre from 1 February 2023 to 3 June 2023 after obtaining ethical approval from the Institutional Review Committee. After a comprehensive medical eye examination, sub-foveal choroidal thickness measurement was performed using enhanced depth imaging optical coherence tomography at the baseline and subsequent interval afterwards. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 60 eyes, the mean amplitude of the diurnal variation of subfoveal choroidal thickness was 35.16±14.08 microns (31.59-38.72, 95% Confidence Interval). The mean amplitude for the right eye was 36.30±14.08 microns, and for the left eye, it was 34.23±14.08 microns. The amplitude of diurnal variation of subfoveal choroidal thickness from this study was found to be similar to other studies done in international settings. choroid; circadian rhythm; cross-sectional study; Ophthalmology.

BILATERAL CONGENITAL MYDRIASIS WITH ACCOMPANYING MIXED DEVELOPMENTAL DELAY

Introduction: Congenital bilateral mydriasis is a rare condition characterized by fixed dilated pupils unresponsive to light. It may occur associated with cardiovascular syndrome, gastrointestinal malformation, or developmental delay. Referred causes in comprehensive differential diagnosis for congenital mydriasis include alterations in ocular structures, ocular innervation alterations and others secondary to trauma, infection, or topical medication.&#x0D; Case Illustration: A 10 months-old boy presented to the hospital with large pupils in both eyes since birth. He has a persistent pupillary membrane with 9 mm diameter of pupil and unable to respond to light in both eyes. The pupillary response test using pilocarpine solution 0.1% showed no difference in diameter of pupils. Comprehensive pediatric examination revealed developmental delay. Computed tomography and laboratory result (laboratory blood count, toxoplasmosis, and cytomegalovirus) within normal limit. After eight months follow up, no significant change in pupil size or light responsiveness was found.&#x0D; Discussion: Comprehensive examination of anterior to posterior segments of the eyes is imperative on the lookout for underdiagnosed diseases. Clinical assessment remains vital for guiding investigations. Observation is required to detect the presence of certain systemic abnormalities that frequently do not manifest at birth.&#x0D; Conclusion: Congenital mydriasis can be diagnosed quickly in ordinary conditions, but it can be quite challenging when it presents as a coincidental finding of other spectrum diseases. It is important to perform a comprehensive general and eye examination to rule out any serious condition related to it.&#x0D; Keyword: Bilateral congenital mydriasis, dilated pupil, mixed developmental delay, pediatric ophthalmology

Оценка клинической эффективности нового способа адаптивного управления инфузией при факоэмульсификации

Reduction of the adverse effects of intraoperative intraocular pressure fluctuation referred to as post-occlusion surge on the intraocular structures is an important task for ensuring phacoemulsification safety. In this regard, the method to control infusion during phacoemulsification based on controlling the infusion and aspiration flow rates in combination with monitoring of vacuum parameters was developed. The study was aimed to provide comparative assessment of clinical and functional characteristics of the eye in patients after phacoemulsification using the new and already existing adaptive infusion control methods. A total of 38 patients aged 66.4 ± 7.8 years (15 males and 23 females) in the index group (Optimed Profi system with the use of new method) and 35 patients aged 68.7 ± 7.5 years (16 males and 19 females) in the control group (Centurion Vision System with Active Fluidics) underwent surgery due to cataract. The patients underwent comprehensive eye examination before surgery and on days 1, 7, 30, months 3, 6 after surgery. The smaller loss of corneal endothelial cells on months 3 and 6 after surgery was observed in patients of the index group with grade III and IV cataract (p &lt; 0.05). Comparison of macular microcirculation parameters revealed the reduced FAZ area by month 6 of postoperative follow-up in the index group, along with the increased total vascular density of the deep vasculature (p &lt; 0.001). A significant decrease in the total density of the superficial and deep vascular plexuses by month 6 of postoperative follow-up was observed in the control group (p &lt; 0.05). The use of new adaptive infusion control method contributes to effective phacoemulsification of cataracts of varying density with the lower percentage of the corneal endothelial cells lost in the late postoperative period.

Prevalence of Comprehensive Eye Examination in Preschool Children With Eye Conditions

IntroductionThe study's purpose is to assess the prevalence of comprehensive eye examinations (CEE) in multi-ethnic preschool children, including children with visually significant eye conditions, and identify factors associated with CEE. MethodsA sample of 9,197 African American (AA), Hispanic (HS), Asian American (AS), and non-Hispanic White (NHW) 6- to 72-month-old children was recruited for the Multi-Ethnic Pediatric Eye Disease Study from 2003-2011. Logistic regression performed in 2022 identified independent factors associated with parent-reported history of CEE. The proportion of children with previous CEE and the proportion with undetected amblyopia or strabismus were measured. ResultsCEE prevalence was 6.3% overall, and 38.3%, 24.8%, 19.1%, 15.1%, and 9.8% among children with strabismus, amblyopia, significant anisometropia, hyperopia, and astigmatism, respectively. Children without prior CEE were more likely to have undetected amblyopia or strabismus than those with CEE history (Ps<0.001). CEE prevalence was higher among older children. Prevalence varied by race/ethnicity, with 8.1%, 7.9%, 6.3%, and 4.9% of NHW, AS, AA, and HS children having had prior CEE, respectively; however, the differences did not remain after adjusting for other associated factors. Older age, a primary caregiver with a college/university degree or higher, having vision insurance, gestational age <33 weeks, neurodevelopmental disorder diagnosis, strabismus, and ocular disease history were all associated with a relatively higher CEE prevalence in multivariable analyses (P≤0.003 for all). ConclusionsCEE was uncommon among preschool children, including those with treatable vision disorders. Interventions, like parent education and vision insurance, are needed to improve CEE access and utilization for at-risk preschool children.

Assessment of dry eye using Schirmer test in patients attending a tertiary hospital eye clinic in Nigeria

Background: Dry eye disease (DED) is a frequently encountered ocular morbidity seen among adult patients attending ophthalmic clinics in Nigeria. It can be assessed using different methods although there is differing consensus on reliable tests for accurate diagnosis.&#x0D; Aim: The aim of this study was to assess DED using Schirmer 1 without anaesthesia among adult patients attending the Eye Clinic in a tertiary hospital in Calabar.&#x0D; Methodology: This was a cross sectional study among adult patients who attended the Eye Clinic of University of Calabar Teaching Hospital who were recruited consecutively from January 1st to March 31st, 2019. All consenting participants had comprehensive eye examination and were assessed for DED using the Schirmer 1 Test. Test values of less than 10mm were diagnostic of aqueous tear deficiency. Initial data categorization yielded frequencies, percentages and proportions. Categorical variables were analysed using Chi-square test and continuous variables using Student’s t-test. Statistical significance was found where p-values were &lt;0.05 at one degree of freedom.&#x0D; Results: Overall, 73 participants were included in the study 29 males and 44 females with male-female ratio of 1:1.5, and the prevalence of DED was 28.8%. Most participants had normal distance visual acuity in both eyes. There was a statistically insignificant inverse linear relationship between age and Schirmer 1 test. The relationship between gender and Schirmer 1 test values and consequently for dry eye was statistically significant, p 0.04.&#x0D; Conclusion: This study showed no significant association between DED and age. Female gender was associated with a higher risk of DED but a significant association between DED compared to the male gender. Its assessment in persons with other ocular complains is important. Primary and secondary prevention strategies are recommended.

Comparison of anticipation skills and reaction time in normal adults using a constructed anticipation timer

Background: In the realm of sports, the ability to navigate accurately through a dynamic environment is an important factor for the coordination of speed and balance. Athletes engaged in sports that involve the swift movement of balls or targets, such as catching a baseball or hitting a tennis ball, rely on a complex interplay of perceptual abilities to succeed. Purpose: Construction of a visual anticipation timer to assess and train the anticipatory skills and reaction time. Methods: We conducted a prospective experimental study. Fifty-one subjects were recruited and informed consent was obtained. They underwent a comprehensive eye examination. We excluded subjects with the best corrected visual acuity worse than 6/6, N6, and those with ocular and systemic diseases. We constructed an anticipation timer with LED lights, push buttons, a resistor, and an Arduino board. The lights are placed vertically at a gap of 2.5cm. The participants were asked to anticipate a time when the last LED light would be on and press the button accordingly. The discrepancy between the “exact time” and the participants’ “anticipated time” was quantified as an error. We measured the error count for each participant before and after the training. The same anticipation task was given as training for 15 min. The participants were given a break of 5 min after the training session and before the post-training measurement. Results: The mean age of the 51 participants was 18.51 ± 1.41 years. The Shapiro-Wilk test showed that the data were not normally distributed (W = 0.758; P &lt; 0.001). We performed the Wilcoxon signed-rank test to find the difference in error counts between pre- and post-training sessions. This showed a significant reduction in error count in the post-training values compared to pre-training values. (p = 0.002; z = −3.044). The mean error count for pre- and post-training sessions was 2.22 and 0.90, respectively. Conclusion: The error counts have been significantly reduced in post-training sessions using a constructed anticipation timer. This study shows that repeated task of anticipation improves the accuracy of the anticipation. Anticipation training makes the person react faster and more accurately. Future scope: The constructed instrument is planned for validating different professions and age groups to understand the importance of anticipation and its cognitive involvement.

The Prevalence and Severity of Acquired Blepharoptosis in US Eye Care Clinic Patients and Their Receptivity to Treatment.

To assess the presence and severity of acquired blepharoptosis (ptosis) among patients visiting an eye care clinic and the receptivity of eligible patients to pharmacologic treatment with oxymetazoline 0.1% ophthalmic solution. Patients aged 50 years or older who had a scheduled clinic appointment for any reason (eg, dry eye, cataract surgery consultation) were asked to respond to written questions about lid position and select whether their upper lid position most closely matched one of 4 images shown to them corresponding to no, mild, moderate, or severe ptosis. Patients selecting any of the mild, moderate, or severe ptosis were offered treatment with oxymetazoline 0.1% ophthalmic solution, barring any medical contraindications. The outcome measures were the proportion of patients with each self-reported lid position level (none to severe ptosis), the proportion of patients with asymmetric ptosis, and the proportion of patients willing to accept the treatment. Data for 188 eyes of 94 patients were analyzed. Overall, 73.4% of patients had ptosis in at least one eye, and 25.5% had an asymmetric upper eyelid presentation. The proportions of patients with self-reported mild, moderate, or severe ptosis in at least one eye were 41.5%, 25.5%, and 6.4%, respectively. Among those patients eligible for treatment, 19.7% were willing to accept the treatment. Based on patients' self-assessment of lid position, this study suggests a higher prevalence of ptosis than reported previously. Evaluation of the eyelids should be a standard part of the comprehensive eye examination.

The Impact on Vergence Parameters After Smartphone Gaming.

To evaluate the impact of smartphone gaming on the vergence system of the eye. A 5-month (from March 2023 to August 2023) comparative and experimental research was conducted. Eighty-two participants with a mean age of 21.98 ± 2.26 years were present in the study. Prior to assessing accommodation and vergence system characteristics, participants underwent a comprehensive eye examination. The participants were asked to play a shooting game on a smartphone for 30 minutes at a 40 cm distance. Measurements of the vergence parameters were taken before and after the activity and afterwards were compared. Non-parametric tests were used to compare pre- and post-task measurements. The Wilcoxon signed-rank test was used to compare the variables: Negative fusional vergence (NFV), Positive fusional vergence (PFV), Near point of convergence (NPC), and Vergence Facility (VF), with the alpha error set at 5%. The mean age of the participants was 21.98 ± 2.26 years. Post-task, the vergence parameters: NPC (p < 0.001), NFV for near distance (p < 0.001), PFV for near distance (p < 0.001), and VF (p < 0.001) showed significant decrease in vergence parameters. The study shows smartphone gaming for 30 minutes affects the vergence system, leading to binocular vision anomalies in young individuals.

The Spectrum of Ocular Manifestations among Renal Transplant Recipients

Purpose: The study aims to report various ocular manifestations among renal transplant recipients. Methods: The cross-sectional study was conducted on renal transplant patients, with at least 4 months of posttransplant duration, attending a nephrology clinic. A comprehensive ophthalmic evaluation was performed to record various ocular manifestations. The statistical association between ocular findings and pretransplant as well as posttransplant duration was assessed. Results: One hundred and twenty-three eyes of 62 patients, with a mean age of 37.6 ± 8.2 years and functional graft, were included in the study. Diabetic nephropathy was found to be the most common underlying cause of end-stage renal disease (ESRD) and renal transplant. Hypertensive retinopathy (37.4%) was found to be the most frequent ophthalmic manifestation, followed by diabetic retinopathy (24.39%), dry eye (22.76%), cataract (18.69%), and change in refractive error (17.89%). The occurrence of hypertensive retinopathy and refractive power change was found to be significantly associated with pretransplant dialysis duration. In contrast, concerning the posttransplant period, the frequency of all the major ocular manifestations, except the dry eye, was observed to be statistically significant. Conclusion: Patients with ESRD and renal transplant should be advised to undergo regular comprehensive eye examinations. Many ocular manifestations are preventable and/or treatable, thus interdisciplinary partnership between nephrologists and ophthalmologists is warranted to improve vision and quality of life in transplant recipients.

Intravitreal injection of methotrexate in persistent diabetic macular edema: a 6-month study.

Diabetic macular edema (DME) affects approximately 10% of patients with diabetes mellitus. This condition can cause blurred or distorted vision, which significantly affects the quality of life of these patients. We evaluated the therapeutic effects of intravitreal methotrexate (MTX) injections on persistent DME. This prospective interventional case series included patients with confirmed persistent DME that was unresponsive to previous standard treatments. The patients underwent comprehensive eye examinations and macular imaging with optical coherence tomography (OCT). A single intravitreal MTX injection (400 µg MTX in 0.16 mL solution) was administered, followed by patient assessments at 1, 3, and 6 months after injection. Best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), macular thickness (MT), and central subfield thickness (CST) were measured at baseline and post-injection to evaluate treatment efficacy. We included 33 eyes of 30 patients with a mean (standard deviation [SD], range) age of 62.7 (8.3, 44 to 77) years, of whom 17 (56.7%) were men and 13 (43.3%) were women. All participants had type 2 diabetes mellitus, with a mean (SD, range) duration of 17.0 (6.8, 10 to 31) years. Most participants (n = 27 eyes, 81.8%) had non-proliferative diabetic retinopathy, and six eyes (18.2%) had regressed proliferative diabetic retinopathy. Four eyes (12.1%) had undergone prior macular laser photocoagulation. The mean (SD) number of prior intravitreal bevacizumab injections was 3.4 (0.8), and 29 eyes (87.8%) had received one intravitreal triamcinolone injection. During the study period, a statistically significant difference was observed in CST (P < 0.05); however, no statistically significant differences were observed in BCDVA, MT, or IOP (P > 0.05). Pairwise comparison revealed a significant decrease in CST at 6 months post-injection compared to the baseline value (P < 0.05). During the investigation period, no side effects of MTX, such as macular edema, retinal tears, vitreous hemorrhage, endophthalmitis, or vision loss, were observed. A single intravitreal MTX injection significantly reduced CST in patients with persistent DME, without relevant safety concerns. However, no significant improvement in functional outcomes was observed. Therefore, there is no strong evidence to recommend its use as a treatment for pDME. Further studies, preferably randomized clinical trials with long-term follow-ups, are warranted to assess the long-term efficacy, safety, and potential benefits of intravitreal MTX for the treatment of persistent DME.

Understanding visual snow syndrome: A retrospective study from a tertiary eye care center.

Visual snow syndrome is a debilitating neurological condition. A comprehensive eye examination may not detect any abnormalities in this condition. Presently the condition is recognized only through the history elicited. Hence, it becomes important to understand the presenting complaints and profile of these patients. A retrospective study at a tertiary eye care center was undertaken to achieve this goal. Electronic medical records of patients presenting to a Binocular Vision and Orthoptics clinic were reviewed. Records of the patients containing keywords such as "light sensitivity, shadowing, visual snow, multiple images, and night vision" were retrieved and inspected. Those matching the diagnostic criteria of visual snow syndrome were included in the study. A total of 33 patients (average age ± standard deviation: 29.7 ± 9.8 years) were identified. Majority of the patients were males (69%). All the patients had logMAR visual acuity 0 or better in each eye. The most prominent (84.4%) presenting symptom was palinopsia (or afterimage or trailing). About 34.4% complained of floaters (including snow-like appearance). More than half (54.6%) of the patients also had binocular dysfunction. Visual snow syndrome is a relatively new condition on the rise, with unclear pathology. The symptoms of this condition can easily be confused with regular floaters or black spots seen in vitreous and retinal pathologies. In the absence of such pathology, an elaborate history should be elicited, and the distress of the patient should be acknowledged. The patient should also be reassured that this is not a blinding condition.