Dilated Fundus Examination Research Articles

Circumscribed Choroidal Hemangioma Simulating Choroidal Melanoma on Advanced Ultrawide-Field Pseudocolor Retinal Imaging: A Case Series

The purpose of this case series was to evaluate the features of circumscribed choroidal hemangioma on pseudocolor ultrawide-field (UWF) retinal images simulating choroidal melanoma and compare it to fundoscopic appearance. All four patients underwent full ophthalmological examination, including dilated fundus examination, ultrasonography, and UWF imaging (UWFI). All circumscribed choroidal hemangioma appeared clinically as orange-red choroidal lesions which were echodense with regular internal structure on ultrasonography. All lesions appeared green-grey in color on pseudocolor UWFI. Pseudocolor UWFI of circumscribed choroidal hemangioma represents distortion of true color appearance and may simulate choroidal melanoma. [Ophthalmic Surg Lasers Imaging Retina 2023;54:292-296.].

Broca’s Aphasia Caused by Hemorrhagic Stroke in a Young Patient: A Case Report

Broca aphasia is a non-fluent aphasia in which the output of spontaneous speech is markedly diminished and there is a loss of normal grammatical structure. We report a case of aphasia presenting different features of aphasia following cerebral hemorrhage in the left frontoparietal lobe, which includes Broca's area. A 25-year-old man presented to our emergency department with a headache, Broca aphasia, and difficulty in vision that started two days ago. Bilateral hemorrhagic areas were seen in dilated fundus examination. A CT scan was performed and showed multiple intracranial hemorrhages. Although stroke is considered a disease of the elderly, it can also be present among young people. An underlying malignancy may be the trigger for hemorrhagic ischemia. Injury to the frontal regions of the left hemisphere impacts how words are strung together to form complete sentences. This can lead to Broca's Aphasia.

Demographics and Clinical Patterns of Retinopathy of Prematurity at the University of Teaching Hospitals, Women and Newborn Hospital

Background: Retinopathy of prematurity (ROP) is a disorder of the developing retina of very low birth weight (VLBW) preterm infants. It is an important cause of childhood blindness and is listed as one of the causes of avoidable blindness in the vision 2020 - “The Right to Sight” Programme.
 ROP is more prevalent in highly developed countries where neonatal services’ availability, access and outcomes are good. The survival rates of Very low Birth Weight (VLBW) infant and low gestational age (GA) at the University Teaching Hospital (UTH), Women and Newborn Hospital (WNH) Neonatal Intensive Care Unit has improved.
 Aims: To estimate the prevalence of ROP at UTH, WNH, NICU.
 Study Design: Hospital-based cross-sectional study.
 Place and Duration: Neonatal Intensive Care Unit, Women and Newborn hospital at the University Teaching Hospital, in Lusaka, Zambia between November 2021 to April 2022.
 Methodology: We included 110 (54.5% males and 45.5% females) infants either born at <32 weeks GA or weighed <1500g. Dilated fundus examinations were done at 4 to 6 weeks chronological age or 31 to 33 weeks GA. Medical records were reviewed to identify associated factors.
 Results: Mean gestational age at birth was 30.6±2 weeks ranging from 27 to 34 weeks, mean birth weight was 1422.7±334.3 g ranging from 900g to 2200 g, mean Apgar score at 1 minute was 7±1.3, at 5 minutes the mean was 7.8±0.9, and at 10 minutes the mean was 8.4±0.7. Twenty-six (23.6%) were products of multiple gestations. Hyaline membrane disease was observed in 14 (12.7%), neonatal sepsis in 48 (43.6%), necrotising enterocolitis in 6 (5.5%), patent ductus arteriosus in one (0.9%), and hyperglycaemia in 56 (50.9%) cases.
 Conclusion: Our study found no participant with retinopathy of prematurity at UTH NICU. Further, the study could not make associations between suggested risk factors to the development of ROP. However, being a novel study on this topic in the country, it highlights the importance of setting up screening protocols and their attendant equipment in Special Care Baby Units at UTH and improving neonatal care services.

Sensitivity of Papilledema as a Sign of Increased Intracranial Pressure

Our study evaluates the sensitivity of papilledema as a sign of high intracranial pressure in children. Patients younger than 18 years old, diagnosed with increased ICP, and who had received dilated fundus examination between 2019 and 2021 were retrospectively reviewed. Factors including the patient's age, sex, aetiology, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. We included 39 patients in this study, whose mean age was 6.7 years. The 31 patients without papilledema had a mean age of 5.7 years, and 8 patients (20%) with papilledema had a mean age of 10.4 (p < 0.037). The mean duration of signs or symptoms was nine weeks in patients without papilledema and seven weeks in those with papilledema (p = 0.410). The leading causes of increased ICP with papilledema were supratentorial tumor (12.5%), infratentorial tumor (33.3%), and hydrocephalus (20%) (p = 0.479). Papilledema was statistically significantly more common in older patients. We found no statistical significance between sex, diagnosis, and symptoms. The relatively low incidence of papilledema (20%) in our study shows that papilledema's absence does not ensure the absence of increased ICP, especially in younger patients.

Evaluation of the lamina cribrosa in different stages of diabetic retinopathy.

To evaluate the relationship of the peripapillary retina nerve fiber layer (RNFL) and lamina cribrosa (LC) with diabetic retinopathy (DR) in type 2 diabetes mellitus (DM) cases. Prospective comparative study. This study included 50 non-DR (Group 1), 55 non-proliferative diabetic retinopathy (NPDR) (Group 2), 28 DM cases with proliferative diabetic retinopathy (PDR) (Group 3) and 45 healthy volunteers (Group 4). All participants were evaluated with visual acuity, intraocular pressure (IOP) with Goldman applanation tonometry, anterior segment biomicroscopy, 24 - 2 visual field testing, and dilated fundus examination. Retinal nerve fiber layer (RNFL) thickness, lamina cribrosa thickness (LCT) and anterior lamina cribrosa depth (ALCD) were examined by spectral-domain optical coherence tomography (OCT). There was no difference between the groups in terms of age and gender. Visual acuity (p < 0.001) was significantly different between the groups, while IOP (p = 0.068) was similar. Mean (p = 0.010), superior-temporal (p = 0.024), and superior-nasal (p = 0.011) RNFL thickness decreased significantly in correlation with the stage of DR. LCT decreased significantly as the stage of DR progressed in both vertical and horizontal radial OCT scans (p < 0.001). ALCD was not different between groups (p = 0.954 for horizontal scan, p = 0.867 for vertical scan). Peripapillary RNFL and LCT significantly decreases as the DR stage progresses. The biomechanical effects of the LC may also be responsible for diabetes-induced neurodegeneration.

Choroidal Mass in a Patient with Undiagnosed Pulmonary Langerhans’ Cell Histiocytosis

ABSTRACT Background Langerhan cell histiocytosis (LCH), although not a common cause, should be kept in the differential diagnosis for a patient that presents with a choroidal mass. Case presentation A 28-year-old female presented with a 4-day history of vision loss and associated pain in her right eye. Examination and investigations A dilated fundus examination revealed a deep subretinal, orange, mottled lesion with associated serous retinal detachment. Ultrasonography demonstrated a solid mass at the posterior pole. Fluorescein angiography revealed corresponding, small, punctate, hyperfluorescent areas with leakage and pooling in the late phase outlining the subretinal fluid. Optical coherence tomography confirmed the choroidal elevation and subretinal fluid. In addition to starting oral steroids for addressing the patient’s acute symptoms, a metastatic workup was ordered due to the lesion’s appearance. Diagnosis: Computed tomography (CT) of the chest showed nodular lesions and subsequent lung biopsy was S-100 and CD1a positive, diagnostic of Langerhan’s cell histiocytosis (LCH). Treatment and outcome The patient was treated with six cycles of vinblastine and prednisolone therapy followed with a subsequent taper of steroids. Complete resolution of signs and symptoms was noted. Discussion A review of all reported cases of ophthalmic LCH with or without choroidal involvement was conducted. Diagnostic and therapeutic approaches described in these reportshave been summarized in the current manuscript. This case highlights the importance of pursuing a systemic workup in patients with uveal mass lesions. LCH should be considered in the differential of every choroidal mass.

Imaging-based Biomarkers as Predictors of Response to Anti-VEGF Therapy in Idiopathic Choroidal Neovascularization.

The purpose of this study was to identify biomarkers that predict the response of treatment-naive idiopathic choroidal neovascularization (iCNV) to anti-VEGF treatment. Fourteen eyes diagnosed with iCNV underwent a dilated fundus examination, Swept Source Optical Coherence Tomography (SS-OCT) and Optical Coherence Tomography - Angiography (OCT-A), and were given an anti-VEGF injection. The same examinations were repeated at every follow-up visit. Analysis of the pre- and posttreatment images was done to identify possible biomarkers which were evaluated to check association with decreased need for multiple anti-VEGF injections. At presentation, 11 patients showed a compact pattern, while three patients showed an arborizing pattern on OCT angiography (P = 1). On follow-up imaging, seven patients showed a marked response, five patients showed a moderate response, and two patients showed a mild response to anti-VEGF injection. Among the seven patients showing a marked response, only one required a repeat injection (P = 0.03). On analysis of SS-OCT, a novel Retinal Pigment Epithelium (RPE) healing response was observed in posttreatment imaging of six patients (P = 0.59). A "marked" response to the first anti-VEGF injection results in a more sustained response and is a positive prognostic factor. RPE healing response is an interesting observation that merits further evaluation. Morphology of neovascular membranes has no effect on long-term need for multiple anti-VEGF injections.

Visual outcome in suspected ocular tuberculosis and role of mantoux testing

To determine the role of mantoux test in treatment of ocular TB.Three patients who presented to the OPD with features of anterior Uveitis were examined completely, both systemically and ophthalmologically. BCVA, Color vision, Slit lamp examination, dilated fundus examination was done. Systemic investigations in pertaining to Uveitis was done(CBC, Mantoux, CXR, Serology, ESR).All patients systemically had all investigations negative (including Chest X-ray) except and strong Mantoux reaction with signs of active anterior Uveitis and Vitritis. In collaboration with the department of chest medicine, Anti tubercular treatment was commenced. Patients have recovered from the Uveitis and have improved symptomatically and clinically.Uveitis can be a presenting feature of extra pulmonary TB. Easily available and affordable Mantoux test can help in detecting TB and commencing treatment which can be sight saving. A close follow up for these patients is needed, as they have been started on ATT after testing mantoux strongly positive and should be closely monitored for any ocular toxicity due to ATT.

Retinopathy of prematurity- A clinical study of incidence and risk factors

To know the incidence of retinopathy of prematurity in low birth weight and preterm neonates and study the association between presence of risk factors with incidence of retinopathy of prematurity.It was a hospital based cross-sectional study carried out in 500 newborns having gestational age ≤ 36 weeks or birth weight ≤2.5kg presenting in OPD at G.T. Sheth Eye Hospital, P. D.U. Government Medical College, Rajkot. During 2021-2022 where 500 neonates (≤36 weeks gestational age and ≤2.5kg gm birth weight) were screened as per ICROP guidelines during the procedure after approval of neonatologist/Paediatrician. Informed verbal consent was taken from Patient’s parents or Guardian. And History was taken along with risk factors according to proforma. Anterior segment and dilated detailed fundus examination was done with indirect ophthalmoscopy and 20D lens with all aseptic precautions. Data was recorded and analysis of the data was done using student t- test and chi square test to find p value of the data to the significance of the study results.The incidence of ROP in any stage was 8% in our study which is less than other studies conducted in India. Mean Gestational age among ROP positive neonates was 31.76 weeks (range 27 to 33 weeks). Incidence of APROP in our study was 25% among ROP of any stages. Mean gestational age and birth weight for APROP in our study was 30.4 weeks and 1.77kg respectively. Low birth weight and prematurity were the most important risk factors for developing any ROP. Other significantly associated risk factors in our study were respiratory distress syndrome and age at which oxygen therapy givenIncidence of ROP in our study is less than other studies which is due to less awareness among parents for retinopathy of prematurity and its risk factors. Most of the patients who developed ROP were exposed to oxygen at very early post conceptional age. This shows that rather than oxygen therapy alone age at which oxygen is given is more important.

Risk Stratification on Systemic Target Organ Involvement Associated with Hypertensive Retinopathy.

Hypertensive retinopathy is a common complication among people with hypertension. The current study assessed the risk stratification on systemic target organ involvement of people with hypertensive retinopathy. In a hospital- based cross-sectional study conducted at a tertiary referral eye institute in Nepal, we included consecutive people ≥ 31 years with essential hypertension. Details of histories and systemic target organ involvements were documented. People with un-gradable retinal findings of hypertensive retinopathy and prior retinal surgery were excluded. All participants underwent comprehensive eye examination, including dilated fundus examination. Hypertensive retinopathy was classified by Modified Scheie classification. Multivariate analysis was performed to identify the risks for hypertensive retinopathy and target organ involvement. The study recruited 312 subjects. The mean age was 63.68 ± 12.63 years. The mean duration of hypertension was 7.0 ± 6.5 years. Hypertensive retinopathy was detected in 83.7% (n=261) people and 63.5% (n= 198) had grade 1 hypertensive retinopathy. Target organ involvement was detected in 20.5% (n =64) people. These included cardiac (12.5%; n=39), central nervous (5.1%; n= 16), and renal (4.5%; n=14) systems. In multivariate analysis, concurrent hyperlipidaemia was significantly associated with hypertensive retinopathy and target organ involvement. Target organ involvement increased with the severity of hypertensive retinopathy. Over four-fifths of people with hypertension had hypertensive retinopathy and one-fifth had other systemic target organ involvements. Severity of hypertensive retinopathy and concurrent hyperlipidaemia were associated with target organ involvement. Hypertensive retinopathy can be considered for risk stratification to other target organ involvement in a clinical setting.

Commentary: Scleral penetration or perforation during strabismus surgery.

Commentary: Scleral penetration or perforation during strabismus surgery.

The relationship between renal renal resistive index and hypertensive end-organ damage

Background/Aim: The prevalence of hypertension increases with age and one out of every three adults over the age of 40 has hypertension. Hypertensive end-organ damage is an important predictive factor for patient morbidity and mortality. This study aimed to investigate the role of the renal resistive index (RI) in predicting retinopathy and nephropathy in hypertensive patients. Methods: This study was cross-sectional in design. Sixty hypertensive patients who were followed in Samsun Research and Training Hospital Internal Medicine outpatient clinic were included in the study. In all patients, a routine ophthalmological examination, including visual acuity, anterior segment examination, and dilated ocular fundus examination, was performed. Urinary albumin to creatinine ratio (mg/g) was measured in spot urine samples, and a level ≥30 mg/g was accepted as the presence of proteinuria. Renal Doppler ultrasonography was performed using Esaote mylab x 9 model sonography device vovex probe (C1-8) 3.5 MHz. RI values were measured using Xflow Doppler at the level of interlobular or arcuate arteries of both kidneys. First, the patients were divided into two groups (with or without retinopathy). The patients who had retinopathy were then divided into two groups according to their retinopathy degree. Hypertensive retinopathy was graded according to the Scheie classification. The patients were also divided into two groups according to their proteinuria status (with or without proteinuria). Results: The mean of renal RI was 0.59 (0.04) in patients without retinopathy (n=15), 0.63 (0.05) in patients with grade 1 hypertensive retinopathy (n=29), and 0.66 (0.04) in patients with grade 2 hypertensive retinopathy (n=15). The difference between groups was statistically significant (overall P=0.001). It has been shown that proteinuria develops more frequently in cases in which the renal value is above 0.7, and these results were statistically significant (P=0.034). Conclusion: This study indicates that renal RI increase is a valuable tool for estimating retinopathy and proteinuria in hypertensive patients.

The role of visual electrodiagnostics in management of children with neurofibromatosis type 1.

To evaluate the role of visual electrodiagnostic testing in children with neurofibromatosis type 1 (NF1) despite improved accessibility to magnetic resonance imaging (MRI). The records from 39 children (78 eyes, 15 boys, 24 girls, average age at last visit of 11.5 ± 4.3years, average follow-up time of 7.8 ± 3.9years) with genetically confirmed NF1 were retrospectively analysed. They all underwent a thorough ophthalmological investigation, including age-appropriate visual acuity testing, anterior segment evaluation for Lisch nodules and a dilated fundus examination. If children were cooperative enough, colour vision was tested using the Hardy-Rand-Rittler test, visual fields were evaluated with Goldmann perimetry. All performed MRI of the brain and orbits as part of the standard of care protocol. Visual electrodiagnostics included electroretinography (ERG) and visual evoked potentials (VEP) using a standard protocol in older children, whereas with less cooperative children a modified protocol according to the Great Ormond Street Hospital (GOSH protocol) was used. The average visual acuity was 0.8 ± 0.3, colour vision was abnormal in 6%, perimetry in 8%, Lisch nodules were present in 62%, and the optic disc was pale in 66% of all eyes. Plexiform neurofibroma of the eyelid/orbit was present in 4%. Optic pathway glioma (OPG) was detected with MRI in 22 (57%) and in 6/22 treatment was indicated. Other intracranial NF1-related lesions were documented in 70% of children. VEP were abnormal in 16/39 of all children with NF1 (41%) comprising 14/22 (65%) of children with confirmed OPG and 2/17 (12%) of children without OPG. All full-field and pattern ERG responses were within normal limits. All individual VEP results are described and three cases from this cohort of children are presented in detail to illustrate the importance of VEP testing. In Case 1, VEP abnormality suggested subsequent MRI of the brain under general anaesthesia, which was otherwise contraindicated according to normal clinical findings and his young age. In Cases 2 and 3, VEP provided more precise functional information during the follow-up of OPG, while other psychophysical tests remained unchanged. Electrodiagnostics has multifactorial role and importance in children with NF1, either when visual pathway function is impaired in young children, even before MRI under general anaesthesia and other psychophysical tests can be performed, as well as for a more precise monitoring of the visual pathway function before potential treatment of OPG, or after it, to evaluate its success.

Visual evoked potential changes following Botox administration in patients with blepharospasm.

To examine visual evoked potential (VEP) changes following botulinum toxin type A (BTA) administration in patients with blepharospasm. Patients diagnosed with blepharospasm receiving BTA administration were included in the study. Three groups, a control group and two study groups (patients examined 14days after BTA administration-Study Group 1, and patients examined 28days after BTA administration-Study Group 2) were evaluated. Dilated fundus examinations were performed following detailed ophthalmological examinations and VEP tests. Keypoint (Dantec, Denmark) and ISCEV criteria were adopted for pattern VEP (PVEP) recording. BTA was applied in the form of local injections at a total 15-30 units, at 2.5-5 units per injection. A mean 19.4 ± 3.2 units of BTA was used for each eye. N70 (ms), P100 (ms), and P100 (uV) values were statistically significantly lower in both study groups following drug administrations compared to the control group (p < 0.001 for all). Significant positive correlation was observed between increased P100 amplitudes and age in the control group (p = 0.008, r = 0.200). Significant negative correlation was observed between the BTA units used and decreased P100 amplitudes in both study groups 1 and 2 following drug administrations (p = 0.017, r = - 0.180 and p = 0.043, r = - 0.153, respectively). VEP may be an important method in the diagnosis and follow-up of blepharospasm and in determining the success of drug administration and additional therapeutic requirements.

Cost-effectiveness Analysis of a Personalized, Teleretinal-Inclusive Screening Policy for Diabetic Retinopathy via Markov Modeling

Although teleretinal imaging has proved effective in increasing population-level screening for diabetic retinopathy (DR), there is a lack of quantitative understanding of how to incorporate teleretinal imaging into existing screening guidelines. We develop a mathematical model to determine personalized DR screening recommendations that utilize teleretinal imaging and evaluate the cost-effectiveness of the personalized screening policy. A partially observable Markov decision process is employed to determine personalized screening recommendations based on patient compliance, willingness to pay, and A1C level. Deterministic sensitivity analysis was conducted to evaluate the impact of patient-specific factors on personalized screening policy. The cost-effectiveness of identified screening policies was evaluated via hidden-Markov chain Monte Carlo simulation on a data-based hypothetical cohort. Screening policies were simulated for a hypothetical cohort of 500 000 patients with parameters based on the literature and electronic medical records of 2457 patients who received teleretinal imaging from 2013 to 2020 from the Harris Health System. Population-based mathematical modeling study. Interventions included dilated fundus examinations referred to as clinical screening, teleretinal imaging, and wait and watch recommendations. Personalized screening recommendations based on patient-specific factors. Accumulated quality-adjusted life-years (QALYs) and cost (USD) per patient under different screening policies. Incremental cost-effectiveness ratio to compare different policies. For the base cohort, on average, teleretinal imaging was recommended 86.7% of the time over each patient's lifetime. The model-based personalized policy dominated other standardized policies, generating more QALY gains and cost savings for at least 57% of the base cohort. Similar outcomes were observed in sensitivity analyses of the base cohort and the Harris Health-specific cohort and rural population scenario analysis. A mathematical model was developed as a decision support tool to identify a personalized screening policy that incorporates both teleretinal imaging and clinical screening and adapts to patient characteristics. Compared with current standardized policies, the model-based policy significantly reduces costs, whereas it is performing comparably, if not better, in terms of QALY gain. A personalized approach to DR screening has significant potential benefits that warrant further exploration. Proprietary or commercial disclosure may be found after the references.

A window of opportunity against diabetes: frequency of microvascular and macrovascular complications in prediabetes

Objectives: To determine the chronic complications of diabetes mellitus (DM) in patients with prediabetes, and to compare prediabetics with normoglycemic group participants in terms of the presence of the complications of DM. Methods: An observational study was conducted between December 2018 to April 2019. The patients aged 18-65 years were recruited from an internal medicine outpatient clinic of a tertiary care hospital. A total of 106 prediabetic patients and 54 normoglycemic subjects were included to the study. OGTT-0th, OGTT-2nd and HbA1c levels, lipid parameters, blood pressure, the homeostasis model assessment of insulin resistan (HOMA-IR), body mass index (BMI) were estimated. Nephropathy (urine protein/urine creatinine ratio, serum creatinine [sCre], Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation-- creatinine clearance), retinopathy by dilated fundus examination and neuropathy (10-g monofilament testing and electroneuromyography [ENMG]) were assessed. Results: Age, gender, BMI, HOMA-IR, smoking status, lipid parameters, systolic blood pressure were similar in both groups. The values of oral glucose tolerance test (OGTT)-0th, OGTT-2nd and glycated hemoglobin (HbA1c) were higher in prediabetics. Although not statistically significant, proteinuria was slightly more occurred in the prediabetics than the controls. sCre was significantly higher, and CKD-EPI equation was significantly lower in prediabetics than in controls (p = 0.012, p = 0.001, respectively). We did not detected diabetic retinopathy in any participants. Neuropathy was slightly more occured in prediabetics, but it was not significantly different (p = 0.309). There were no correlation between sCre, CKD-EPI, proteinuria and age, BMI, HOMA-IR, OGTT-0th, OGTT-2nd, and HbA1c. Conclusions: Managing the prediabetes by early diagnosis is very meaningful in terms of prevention from DM and its complications. So, prediabetes may be a window of opportunity for diabetes associated morbidity.

Refractive errors and ocular findings in children and adolescents with mental disorders: a retrospective study

BackgroundAn increasing prevalence of mental disorders (MDs) has been reported among children and adolescents. However, only few studies have conducted ocular examinations, including those on refractive status, in these groups of patients. Thus, the purpose of this study was to evaluate the refractive status and ocular findings in children and adolescents with MDs compared with matched controls with similar socioeconomic backgrounds.MethodsA total of 178 participants with MDs and 200 controls were recruited between April 2021 and May 2022. All the children and adolescents underwent cycloplegic or noncycloplegic autorefraction and retinoscopy, slit-lamp biomicroscopy, and dilated fundus examinations. Ocular alignment was assessed using Hirschberg, Krimsky, or prism cover tests. The prevalence of refractive errors and ocular findings was the main outcome.ResultsTwenty-seven percent of patients with MDs and 8% of controls had ocular findings, the most common of which were conjunctivitis, keratitis, and trichiasis. For refractive status, 70% (124/178) of patients with MDs had myopia ≤-1.00 DS, and 2% (4/178) had hyperopia ≥+2.00 DS. In the control group, 70% (140/200) of patients had myopia ≤-1.00 DS, and 1% (2/200) had hyperopia ≥+2.00 DS. No differences were observed between the MD and control groups. However, the patients in the MD group (14.25±2.69 years) were significantly more susceptible to strabismus (P<0.05) and amblyopia (P<0.01) than those in the control group (13.65±3.04 years). There was a substantial difference between the two groups in the time spent on screen-based devices (P<0.001). Furthermore, mental retardation (OR=3.286, P<0.01), emotional disorders (OR=2.003, P<0.01), and adjustment disorders (OR=2.629, P<0.01) were associated with an increased risk of amblyopia. Depression (OR =1.362, P<0.01) and emotional disorders (OR=2.205, P<0.01) were associated with a higher prevalence of strabismus.ConclusionOphthalmological examinations should be performed in children and adolescents with MDs because MDs are associated with a high prevalence of refractive errors and ocular diseases. Detection and intervention of ocular and refractive findings in children and adolescents with MDs are necessary and effective in alleviating the economic burden in healthcare and improving individuals' quality of life

Sex Difference in the Association between Depression and Adherence to Recommended Dilated Eye Examinations among Patients with Diabetes: Findings from National Health and Nutrition Examination Survey

Introduction: The relationship between depression and adherence to regular dilated fundus examination (DFE) in patients with diabetes remains unclear. This study aimed to assess the association between depression and adherence to annual or biennial DFE among individuals with diabetes. Methods: In this cross-sectional study, we used the National Health and Nutrition Examination Survey database from 2005 to 2016 which contains information on demographics, clinical characteristics, health-related factors, and the time since last DFE. Participants were classified as having depression based on a score of >9 on the Patient Health Questionnaire-9. The main outcomes were the association between depression and the adherence of patients with diabetes to annual or biennial DFE. The second objective was to explore the potential influence of gender in this association. The independent association of depression with DFE compliance was explored by a series of multivariate logistic regression analyses (overall sample and then stratified by sex). Results: In total, 3,656 eligible participants were identified. The adherence rates to annual or biennial DFE were all higher for participants without depression than those with depression (64.8% vs. 56.1% and 80.3% vs. 69.7%, respectively). In the multivariate analyses, depression was neither independently associated with the adherence to annual DFE nor biennial DFE in the overall sample. An interaction was observed between depression and gender for the adherence to annual or biennial DFE (p = 0.017 and p = 0.026, respectively). When analyses were stratified by sex, female patients with diabetes and depression had a significantly increased odds ratio (OR) of being nonadherent to annual and biennial DFE (OR = 1.52, 95% confidence interval [CI]: 1.02–2.25, p = 0.039; OR = 1.55, 95% CI: 1.02–2.35, p = 0.039, respectively). However, this relationship was not evident in men with diabetes. Conclusions: The independent association between depression and DFE compliance varied by sex, that is, only female patients with diabetes and depression were at a higher risk of nonadherence to annual or biennial DFE compared to those without depression.

Determinants for Anemic Retinopathy.

To study the prevalence of fundus lesions in anaemics and define the hematological risk factors for retinopathy using the receiver operating characteristic curve analysis. For this retrospective study, patients ≥18 years and diagnosed with anemia with dilated fundus examination by a retina specialist from May 2019-April 2020 were included. Anemic retinopathy (AR) was present if hemorrhages in different layers of the retina, Roth's spots, exudates, cotton wool spots, retinal edema, and optic disc changes were noted. Patients with secondary anemia were excluded. Two groups were identified: Group 1: Patients with AR; Group 2: Patients with no AR with normal fundus. Demographic features, fundus findings, and hematological parameters were noted. 38 (30%) eyes of 23 patients had AR; 90 (70%) eyes of 47 patients had no AR. The mean age in Group 1 and Group 2 was 54.7±18.9 and 58.6±15.3 years, respectively. Low hemoglobin (Hb) [mean = 7.82±1.64 gm/dl, p=<0.001] and hematocrit [mean = 26.93±5.22 %, p=0.002] values were noted in the AR group. AUC values for Hb (0.737) and hematocrit (0.719) were higher for the AR group. Hb < 8.95g/dl could predict AR with 85.8% sensitivity and 68.9% specificity, and hematocrit < 30.5% could predict AR with 80% sensitivity and 53.2% specificity. On regression analysis, Hb (p<0.001) and hematocrit (p=0.000) were associated with AR. Retinopathy is frequently seen in severe anemic patients. It is recommended that patients having low anemia should undergo a retinal examination.

Patients unfit for Lasik can benefit from implanted phakic copolymer lens

Objective: To assess visual outcomes and safety of implantable phakic copolymer lenses (IPCLs)V2 model in patients with moderate to high myopia. Methodology: This prospective interventional cross-sectional study involving 40 eyes of 27 patients who had IPCL implantation for correction of myopic and myopic-astigmatism was carried out at Dar Al-salam private eye hospital, Baghdad from 1st May 2017 to 1st May 2020. Pre-operative and post-operative parameters included visual acuity by logMAR system, refraction, detailed examination by slit lamp bio microscopy, dilated fundus examination, intraocular pressure measurement, anterior chamber depth measurement by a pentacam in addition to white-to-white diameter measurement preoperatively. All had IPCL implantation and follow-up period was 12 months. Results: We found that 26 (96.3%) patients are happy to extremely satisfied with the procedure. BCVA was 0.275 logMAR preoperatively. Uncorrected visual acuity (UCVA) in the follow-up period was 0.035, which was considerably better than preoperative (BCVA). All patients had the same or improved VA post-operatively and remained stable during follow-up. The mean residual was -0.06 D. (min-1.37-max0.37). Conclusion: IPCL V2 used for correction of high ametropia resulted in a highly significant improvement in postoperative uncorrected visual acuity with minimal controllable complications and excellent patient’s satisfaction.