Normal Acuity Research Articles

A comparative study of efficacy, tolerability and safety of 0.03% tacrolimus eye ointment and 0.05% cyclosporin eye drops in the treatment of vernal keratoconjunctivitis

Background: Vernal keratoconjunctivitis (VKC) is a common, chronic, bilateral, recurrent, allergic, inflammatory disease of the ocular surface primarily affecting young males in dry, hot climates such as India.Objectives: To compare the efficacy, tolerability and safety of 0.03% tacrolimus eye ointment and 0.05% cyclosporin eye drops in the treatment of vernal keratoconjunctivitis. Methods: A prospective study of 72 patients conducted from December 2017 to February 2021. After having established a diagnosis of VKC and fulfilling inclusion and exclusion criteria, participants were divided into two groups. Group 1 was put on cyclosporin eye drops and group 2 was put on tacrolimus eye ointment. Detailed history and evaluation for symptoms, signs, visual acuity and IOP was done on first visit and subsequently after 6 weeks, 12 weeks and 24 weeks. Results: 72 patients were diagnosed to have VKC, of whom males were 86% and females 13.9%, all belonging to the age group 5 to 14 years and were divided into two groups. Both the groups showed significant reduction in the symptoms and signs with no significant difference in efficacy between the groups and they maintained normal IOP and visual acuity at 6 weeks, 12 weeks and 24 weeks.Conclusion: Both the immunomodulators were equally successful in resolving the signs and symptoms of VKC, tolerable with no significant adverse effects and proved to be a safer alternative to steroids as they caused no elevation of intraocular pressure or any complications associated with the use of steroids.

Clinical Profile of COVID Patients During Recovery Phase at Tertiary Eye Care Centre in South India

BACK GROUND: Though Corona virus -19 first reported in china, Indian population in urban as well as rural areas were badly effected during second wave with involvement of various ocular structures, some patients lost vision due to retinal vascular occlusions, some patients required enucleation and orbital exenteration due to fungus infections of the eye. Patients reported with different ocular disorders were documented and intervened, were included in this study. We tried to understand whether these manifestations were due to Corona Virus or due to immune compression because of systemic disorders in Corona patients treated with oral steroids and unsterile oxygen support. Aim: Purpose is to study the various clinical manifestations noted in COVID-19 patients during second wave after treatment while recovering from the acute illness. Methods: Retrospective interventional study done at tertiary eye care centre. Duration of the study is 3months from April 2021 to June 2021.500 patients were presented to our tertiary eye care centre with various clinical manifestations. All patients underwent detailed systemic and ocular examination. Patients after treatment for COVID-19 at various hospitals across the country were presented to our institute with many opportunistic infections. Apart from history BCVA, Slit Lamp examination, fundus examination, OCT, Fundus Fluorescein Angiography and B Scan done in patients where media was hazy, documentation done in all cases. Systemic examination and other investigation like RT PCR for corona virus was done in all patients. Patients presented with orbital involvement were advised CT Scan orbit. Results: Most of the patients were badly effected with many ocular complications, very few patients could maintain normal visual acuity. Many patients developed diabetes mellitus, probably they were pre diabetics manifested after use of oral steroids. Conclusion: Second wave in India increased the mortality and also effected the quality of the life in survivors. Fatality was high due to various ocular complications in all individuals irrespective of age and immune status.

Mohsin's schoolchildren eye screening program - Analysis of the results

Aim of the Study: To determine the prevalence of ocular morbidity among government schoolchildren from Mohsin's Schoolchildren Eye Screening Program. Design: A school-based, observational study design. Participants: Schoolchildren between 1st and 10th standards across various government schools. Materials and Methods: Students of 429 government schools of Visakhapatnam were covered under this eye screening program. It was a three-staged program. In the first stage, 84,727 students were screened for visual impairment and the presence of any abnormality by trained teachers or optometrists. In the second stage, those who were identified were subjected to a detailed ocular examination and refraction in the school premises by trained optometrists. Glasses were dispensed for those who improved to normal visual acuity and treatment was given for minor ailments by optometrists, residents and ophthalmologists requiring further evaluation were referred to the base hospital for examination and appropriate management by an ophthalmologist in the third stage. Results: 84,727 children from 429 schools were screened. Ocular morbidity was 6.07%. Refractive error was the most common ocular disorder identified in 3.74% with a significantly high rate among secondary schoolchildren (P

Is the Current Treatment of Lazy Eye Based on a False Premise?

Amblyopia (lazy eye) is a neurodevelopmental disorder of vision with no ocular pathology. The loss of vision in the amblyopic eye is assumed to be the main deficit in amblyopia, which has resulted in visual acuity being the primary outcome measure for treatment. Here we used a binocular orientation combination task to quantitatively assess the binocular status, at a stage before stereopsis, by measuring the binocular balance. We set out to determine whether amblyopes who reach the acuity-based endpoint have a residual binocular imbalance. Our results suggest that even amblyopes who have regained normal acuity have residual binocular deficits over a wide range of spatial frequencies. A further control study suggests that these binocular deficits could not be explained by any residual contrast sensitivity deficits of the amblyopic eye. Consequently, amblyopia is not the primary problem and visual acuity is not the appropriate endpoint measure.

Chapter 2 - Amblyopia

Amblyopia is a neurodevelopmental abnormality that results in physiological alterations in the visual pathways and impaired vision in one eye, less commonly in both. It reflects a broad range of neural, perceptual, oculomotor, and clinical abnormalities that can occur when normal visual development is disrupted early in life. Aside from refractive error, amblyopia is the most common cause of vision loss in infants and young children. It causes a constellation of perceptual deficits in the vision of the amblyopic eye, including a loss of visual acuity, position acuity, and contrast sensitivity, particularly at high spatial frequencies, as well as increased internal noise and prolonged manual and saccadic reaction times. There are also perceptual deficits in the strong eye, such as certain types of motion perception, reflecting altered neural responses and functional connectivity in visual cortex (Ho et al., 2005). Treatment in young children consists of correction of any refractive error and patching of the strong eye. Compliance with patching is challenging and a substantial proportion of amblyopic children fail to achieve normal acuity or stereopsis even after extended periods of treatment. There are a number of promising experimental treatments that may improve compliance and outcomes, such as the playing of action video games with the strong eye patched. Although there may be a sensitive period for optimal effects of treatment, there is evidence that amblyopic adults may still show some benefit of treatment. However, there is as yet no consensus on the treatment of adults with amblyopia.

Frequency of presenting visual acuity and visual impairment in Chinese college students.

To obtain the baseline data on presenting visual acuity (PVA) and evaluate the prevalence and associated factors for visual impairment based on PVA in 9070 Chinese college students. The freshmen at a university in southern China, including 6527 undergraduate students and 2543 graduate students, were investigated for some socio-demographic characteristics and underwent routine medical examination, including measuring PVA, height, and weight. Visual impairment was defined according to the new World Health Organization criteria for blindness and visual impairment. In 9070 college students, the mean PVA in the better eye was 0.094±0.163 logMAR. The prevalence of visual impairment based on PVA was 2.7%. Only 38.3% college students had normal visual acuity [PVA equal to 0 logMAR (20/20) in both eyes]. There were 69.8% of students wearing spectacles. Logistic regression showed that home region (non-Guangdong provinces, P<0.0001, OR=1.70) was risk factor for visual impairment while BMI (P=0.001, OR=0.92) was protective factor from visual impairment. Ethnicity (Han Chinese, P<0.0001, OR=3.17) was risk factor for wearing spectacles while age (P=0.01, OR=0.90) was protective factor from wearing spectacles. This study provides the baseline data on PVA and the prevalence of visual impairment in Chinese college students. Our analyses reveal that BMI and home region are associated factors for visual impairment based on PVA, while age and ethnicity are associated factors for wearing spectacles.

Analysis of risk factors, clinical features and visual outcome in cases of non-arteritic anterior ischemic optic neuropathy (NA-AION) at a tertiary eye care centre in India

We did an analysis of risk factors, clinical features and visual outcome in cases of non-arteritic anterior ischemic optic neuropathy (NA-AION) at a tertiary eye care centre in India. This is a prospective, observational, clinical study. A total of 60 eyes of 60 consecutive adult patients with disc oedema, due to non-arteritic AION, presenting in the Neuro-ophthalmology clinic of a tertiary care eye hospital, were enrolled over a period of 18 months (in specified period) according to the inclusion criteria. The study, including patient recruitment and data collection, was approved by the Institutional Review Board. All patients provided written informed consent after they received information about the disease and its relevant investigations along with the risks associated. Sample collection was done by application of inclusion and exclusion criteria on the patients presenting to the clinic. The study was carried out for a period of 6 months for each subject. The major outcomes of the study were: Metabolic Syndromes are the most significantly associated risk factors for the occurrence of NA AION. Clinical investigations mainly show the characteristic findings as mentioned in literature, with very little variation. However the importance of clinical examination, mainly pupillary reaction and fundus evaluation by slit lamp biomicroscopy, cannot be overlooked. Visual acuity is highly variable at presentation with cases even presenting with normal or near normal visual acuity. Visual outcome showed significantly improvement within 6 months of presentation. Non arteritic anterior ischemic optic neuropathy (NAION) was the most common form of ischemic optic neuropathy in our study. It is an idiopathic, ischemic insult of the optic nerve head characterized by acute, monocular, painless visual loss with optic disc swelling. The systemic risk factor which we found to be most strongly associated with was diabetes mellitus followed by systemic hypertension. Also an

Intracerebral giant hydatidosis in an adult woman – A case report

Intracranial hydatid cysts account for 0.5-3% of all the cases of hydatid disease and contribute to 1-2% of all the intracranial space occupying lesions. Rare cases of intracranial hydatid disease have been reported in India. In India, the hydatid disease is more commonly seen in the Kurnool district of Andhra Pradesh, Madurai district of Tamil Nadu and in Punjab. Here we present a case ofa 35-year-old female patient presented to us with diminution of vision, diplopia tempero- frontal lobe which is T1 hypointense and T2 hyperintense measuring 4.5×5.25cms Patient was subjected for surgical excision of cyst. Post operatively patient improved well with no neurological deficits. Histopathology of the lesion confirmed hydatid cyst. Patient was put on oral albendazole 10mg/kg per day and continued for 12 weeks. Patient is on regular follow up with us, with no neurological deficits. and headache since 10 days. Her neurological assessment showed higher mental functions within normal limit and Visual acuity - 6/12 right eye and 6/9 left eye, with normal fundus & right 6th cranial nerve palsy. MRI brain (P+C) done was suggestive of intra-axial well defined cystic lesion in right. Keywords: Intracerebral hydatidosis, Echinococcus, Dowling-Orlando technique, Albendazole

Multiple cranial nerve enlargement in Charcot-Marie-Tooth disease

Hypertrophy of peripheral nerves are commonly reported in patients with demyelinating forms of Charcot-Marie-Tooth disease (CMT).1 Herein, an under-recognised association with hypertrophy of multiple cranial nerves in a patient with...

Factors Associated with and Reasons for Loss to follow-up Among Glaucoma Patients at a Nigerian Eye Hospital

Background: Glaucoma is an emerging vision-threatening disease requiring a life-long management protocol with regular surveillance. Aim: To explore the factors associated with and reasons for loss to follow-up among glaucoma patients. Methods: All adult glaucoma patients who attended Bridget medical Centre (BMC) Eye hospital, Enugu during a two-year period (2016 – 2018) were identified via the medical records. Those who had missed an appointment by at least 12 months were reached via their cellular phones to ascertain their reasons. Information on their socio-demographic and clinical characteristics was retrieved from their records. Data was analyzed using SPSS version 21. Chi-square test was done to identify the factors associated with loss to follow-up. The level of significance was at p&lt; 0.05. Results: A total of 113 patients had glaucoma. They were mainly males, 67(59.3%), retirees with a mean age of 62.0±2SD years. Ninety-four (83.2%) participants were lost to follow-up. The main reasons were forgetfulness, 33(41.2%), and have not noticed any problem in vision, 20(25.0%). Male gender, advanced age, tertiary education, retiree, normal visual acuity, moderate/advanced stage, IOP of less than 21mmHg, more than 5 years of diagnosis and using more than one medication were associated with loss to follow-up. However, only Retiree and IOP of less than 21mmHg were statistically significant. Conclusion: The findings from this study emphasized the need for continual glaucoma education and appointment reminder, especially to Retirees with normal intraocular pressure.

The prevalence of reduced visual acuity in children from an urban district in China from 2002 to 2018.

To investigate trends in the prevalence of reduced visual acuity (VA), a proxy measure for myopia, in an urban district in China. Data were extracted from the dataset of the 2002 and 2018 Annual Survey on Students' Constitution and Health from Yuhua District, Changsha City, China. Children aged 6-15 years were included in the study. VA was measured using a LogMAR tumbling E chart. The prevalence of reduced VA was calculated by age and gender. The chi-square test was used to compare the differences between groups. The final VA analysis included 26217 children in 2002 and 45510 children in 2018. The overall prevalence of reduced VA increased from 28.3% in 2002 to 46.5% in 2018 (P < 0.001). The prevalence of reduced VA started to increase markedly from the age of 14 years in 2002, while in 2018 it started to increase markedly from the age of 9 years. The prevalence of severely reduced VA increased in all age groups from 2002 to 2018 and increased with age (all P < 0.001). In 2002, over 50% of children in all age groups had normal VA. By 2018, the prevalence of normal VA decreased from 61.4% in those aged 6 years to 31.9% in those aged 15 years. The prevalence of reduced VA among children aged 6-15 years in Yuhua District has become more common with age, and there has been a marked increase in the prevalence of reduced VA from 2002 to 2018. The remarkable epidemic of reduced VA started 5 years earlier in 2018 than in 2002. Evidence from the present study suggests that interventions should be launched before the age of 9 years.

SURG-34. MULTIDISCIPLINARY MANAGEMENT OF A PATIENT WITH OPTIC PATHWAY-HYPOTHALAMIC LANGERHANS CELL HISTIOCYTOSIS: A CASE REPORT

Abstract Langerhans cell histiocytosis (LCH) of the Central Nervous System (CNS) is rare. Isolated involvement of the hypothalamic region is much more extremely rare with only 0.04 to 0.6% of the cases. We report a case of a 33 year-old female who presented with a one-year history of amenorrhea and a five-month history of intermittent headache, memory lapse, and somnolence. The patient was of normal body mass index with normal visual acuity and intact visual fields. Laboratory examinations revealed panhypopituitarism with central diabetes insipidus. Cranial magnetic resonance imaging showed a large lobulated mass measuring 1.9 x 2.2 x 2 cm in the suprasellar region which extended to the pituitary infundibulum, hypothalamus and retrochiasmatic region, with surrounding edema. The patient underwent right orbitozygomatic craniotomy and subtotal excision of the mass through subfrontal and transsylvian approaches. Histopathological examination of langerhans cells were observed with positive immunohistochemical stain for CD1a and S100 protein antigen markers establishing a diagnosis of CNS LCH. Thoracoabdominal computed tomography scan and bone scan were done postoperatively and showed no evidence of extracranial lesions. The patient had been receiving prednisone and vinblastine based chemotherapy regimen. She remains to be asymptomatic and on close surveillance. To date, there is no standardized treatment strategy for CNS LCH in the adult population. An accurate histopathologic diagnosis and a specialized multidisciplinary team approach especially involving Oncology, Neurosurgery, Ophthalmology and Endocrinology are critical to optimally tailor possible effective treatment options for patients with this similar disease. Long-term follow-up is crucial due to the increased risk of local recurrence and multisystemic involvement.

Too Many Shades of Grey: Photometrically and Spectrally Mismatched Targets and Backgrounds in Printed Acuity Tests for Infants and Young Children.

PurposeAcuity tests for infants and young children use preferential looking methods that require a perceptual match of brightness and color between grey background and target spatial average. As a first step in exploring this matching, this article measures photometric and colorimetric matches in these acuity tests.MethodsThe luminance, uniformity, contrast, and color spectra of Teller Acuity Cards, Keeler Acuity Cards for Infants, and Lea Paddles under ambient, warm, and cold lighting, and of grey-emulating patterns on four digital displays, were measured. Five normal adults’ acuities were tested at 10 m observationally.ResultsLuminance and spectral mismatches between target and background were found for the printed tests (Weber contrasts of 0.3% [Teller Acuity Cards], −1.7% [Keeler Acuity Cards for Infants], and −26% [Lea Paddles]). Lighting condition had little effect on contrast, and all printed tests and digital displays met established adult test luminance and uniformity standards. Digital display grey backgrounds had very similar luminance and color whether generated by a checkerboard, vertical grating, or horizontal grating. Improbably good psychophysical acuities (better than −0.300 logMAR: (logarithm of the minimum angle of resolution)) were recorded from adults using the printed tests at 10 m, but not using the digital test Peekaboo Vision.ConclusionsPerceptible contrast between target and background could lead to an incorrectly measured, excessively good acuity. It is not clear whether the luminance and spectral contrasts described here have clinically meaningful consequences for the target patient group, but they may be avoidable using digital tests.Translational RelevanceCurrent clinical infant acuity tests present photometric mismatches that may return inaccurate testing results.

Reduced Contrast Sensitivity Function in Central and Peripheral Vision by Disability Glare.

Various glares can decrease visual performance and cause discomfort, thus increasing drivers' risk for traffic accidents in real life. The current study aimed to systematically investigate glare sensitivity in the central and peripheral visual fields by measuring contrast sensitivity function (CSF) under nonglare, steady glare, and transient glare conditions. Nine observers with normal visual acuity in the dominant eye were enrolled. The CSF in central and peripheral vision (the 5° upper left visual field) was measured in a mesopic environment while the stimulus was displayed under three conditions: nonglare, steady glare, and transient glare. An orientation identification task was used to obtain the CSF. After the experiment, the observers were asked to report their level of discomfort in the presence of the glare. The area under the log CSF (AULCSF) and cut-off spatial frequency served as indicators of visual performance. In agreement with previous studies, both steady and transient glare reduced the AULCSF and cut-off frequency. However, the AULCSF and cut-off frequency were reduced more for central vision than for nearly peripheral vision. In addition, the extent of the decreases in the AULCSF and cut-off frequency was greater for steady glare than for transient glare; in contrast, more discomfort was associated with transient glare than steady glare.

Leber hereditary optic neuropathy following head trauma and ocular trauma on contralateral eye: a case report

PurposeTo present a case of activation of Leber hereditary optic neuropathy (LHON) following head and ocular trauma of the fellow eye in the patient with no remarkable symptoms and normal visual acuity prior to trauma.Case summaryA 31-year-old healthy man was referred to our hospital after a traffic accident. He had blowout fractures of medial and inferior orbital wall of the left eye, subcutaneous hematoma of the left forehead, and bony fragment that compressed the left optic nerve. Initially, best-corrected visual acuity (BCVA) was 20/20 in the right and 20/1000 in the left eyes. Relative afferent pupillary defect of the left eye was apparent, and fundus examination revealed choroidal rupture circumferentially crossing the macular area. Nine months later, the patient complained with gradual vision loss in the right eye, which was the contralateral eye of the ocular trauma. BCVA was 20/200, and perimetry revealed cecocentral scotoma in the right eye. BCVA in both eyes reduced to 20/2000 1 year post-trauma. Visual evoked potentials revealed markedly decreased in amplitudes and elongated latencies for both eyes. Mitochondrial DNA analysis revealed a G11778A mutation; therefore, a diagnosis of activation of LHON followed by trauma was made for the previously unaffected carrier.ConclusionsThis is a case in which activation of LHON occurred in a healthy carrier following head and ocular trauma of the fellow eye. This observation suggests the possibility that LHON activation in healthy carriers may occur in patients who experience head or ocular trauma even in the fellow eye.

CHANGES OF THE FOVEAL AVASCULAR ZONE AND MACULAR MICROVASCULATURE WITHIN THE FRAMEWORK OF OCT ANGIOGRAPHY EXAMINATION IN YOUNG PATIENTS WITH TYPE 1 DIABETES (PILOT STUDY).

Learn about the development and changes in foveal avascular zone (FAZ) and vascularity of retina in the surrounding zone, depending on the duration in young diabetic patients type 1 (T1DM). As part of regular one-year examinations of young T1DM patients at the Eye Clinic of the University Hospital Královské Vinohrady in Prague (Czech Republic, EU) from January to December 2019, OCT angiography using the device Spectralis (Heidelberg Engineering) was included. Forty patients aged 18 to 30 years were examined, median 21 years. T1DM was diagnosed in childhood and lasted for more than 10 years. At the same time, acontrol group of forty individuals of similar age, without metabolic and other general disease was examined, normal visual acuity and physiological fundoscopic finding were obligatory. The FAZ size was evaluated in both groups (using built-in function "Draw Region"), also its shape, density decrease and change in character of vascularity of the retina was assessed. In the control group, the FAZ area ranged from 0.06 to 0.4mm², with an average of 0.253 ± 0.092mm² and amedian of 0.27mm². It was not affected by afundamental change in its round shape and the surrounding capillary netting was regular and reasonably dense. In T1DM patients, the FAZ area was in awider range, from 0.05 to 0.64mm², an average of 0.300 ± 0.132mm², and amedian of 0.31mm². The difference in FAZ across-the-board evaluation was statistically significant (p = 0, 009). Diabetic preretinopathy (DpR) was defined by the irregularity of the capillary density up to the manifestation of non-perfusion, in 61% of cases the size of the FAZ was changed. In diabetic retinopathy (DR) there was always an irregularity of the FAZ shape with its enlargement, manifestation of non-perfusion, capillary dilatation and rare microaneurysms. Changes in FAZ size corresponded to the stage of T1DM on the fundoscopic finding of the eye depending on its duration. The initial increased amount of foveal capillaries, which resulted in decreased FAZ area, was followed by agradual decrease in capillaries and increased FAZ area, consistent with the manifestations of DpR. It was accompanied by achange in capillary density in macula to eventual non-perfusion. On the contrary, the increase in the FAZ area and its irregularity accompanied by non-perfusion of the capillary net and microaneurysms corresponded to the development of DR already.

Ophthalmology Consult Protocol for Orbital Fractures Utilizing Evidence-Based Data

Previous retrospective studies demonstrate that emergent evaluation by an ophthalmologist for orbital fractures is not required in visually asymptomatic patients, although a consult is often seen as a necessity in many hospital institutions.1,2 These studies do not specifically focus only on patients who require surgical intervention.1,2 To determine when an ophthalmology consult is indicated for a surgical patient, the maxillofacial and ophthalmology departments at UF Health Jacksonville collaborated for an evidence-based approach utilizing retrospective and prospective data. The retrospective arm looked at patients, ages 18 and older, from 2012-2017, who had an isolated, surgically repaired orbital fracture without pre-operative ophthalmology consultation, and a follow-up in the OMS clinic at least 1 week after surgery. The parameters of extra-ocular movements, visual acuity, and diplopia were determined by the physical exam in both the pre-op and postop setting to determine if the lack of an ophthalmology consult adversely affected the outcome. A total of 84 patients met criteria, and 82 out of 84 had no diplopia postop; the other 2 patients had binocular diplopia postop consistent with diplopia that was also present pre-op. All patients had extraocular movements intact postop, and 100% had visual acuity intact postop. Based on our retrospective results, a prospective arm was created where patients 18 years and older, from August 2019-February 2020, with a surgically repairable orbital fracture were included. Patients with intra-ocular disturbances or a history thereof in the adjacent globe received an ophthalmology consult pre-op according to our designed protocol, while those who did not require a consult following to our protocol did not receive a consult. Of the 26 patients that underwent surgical repair under the prospective arm, 19 did not require an ophthalmology consult, while 7 did receive an ophthalmology consult pre-operatively. Eighteen of the 19 patients without a consult did not have a postop visual complication – normal visual acuity, intact extra-ocular movements, and no diplopia. One of the 19 had postop diplopia consistent with diplopia he presented with pre-operatively. Combining the results of both arms, 103 patients without a pre-op ophthalmology consult were used in the study. Three of the 103 patients had postop diplopia consistent with pre-op diplopia. Over 97% success rate was achieved, as 100 out of the 103 patients had no visual complications following our 3 variables. These results lead the authors to conclude that visually asymptomatic patients with surgically operable orbital fractures do not routinely require an ophthalmology consult using evidence-based data.

Level of Glaucoma Drug Adherence and Its Associated Factors Among Adult Glaucoma Patients Attending Felege Hiwot Specialized Hospital, Bahir Dar City, Northwest Ethiopia.

BackgroundGlaucoma is a chronic optic nerve disease, often asymptomatic in an early stage, which is usually associated with elevated intraocular pressure. Good adherence to ocular hypotensive agents is essential to control the intraocular pressure and optic nerve damage. There is limited information on glaucoma drug adherence and associated factors in Ethiopia, particularly in the study area.ObjectiveTo determine the level of glaucoma drug adherence and associated factors among adult glaucoma patients attending Felege Hiwot Specialized Hospital, Northwest Ethiopia, 2019.Materials and MethodsA hospital-based cross-sectional study was conducted at Felege Hiwot specialized Hospital from March 2019 to May 2019. A systematic random sampling method was used to select 402 study participants. A structured questionnaire was prepared, and adherence was assessed by using self-report questions. The collected data were entered into Epi data version 4.2.2.1 and exported into Statistical Package for Social Science version 23 for analysis. Tables, graphs, frequency, mean, and standard deviation were used for descriptive statistics. Variables with a p-value of <0.2 in the bivariable logistic regression were entered in the multivariable logistic regression, and variables with a p-value of <0.05 under multivariable analysis were taken as statistically significant factors for glaucoma drug adherence.ResultsAmong a total of 390 study participants, 212 (56.2%) were adherent to their topical medication. Early glaucoma (AOR=2.8: 95% CI =1.29–5.91), normal vision (AOR=1.9: 95% CI=1.15–3.09), urban residence (AOR=1.6: 95% CI=1.03–2.51), family support (AOR=1.7: 95% CI=1.06–2.76) and information from pharmacist (AOR=1.8: 95% CI=1.11–2.99) were significantly associated with adherence.ConclusionThe level of glaucoma drug adherence was 56.2% among patients attending Felege Hiwot Specialized Hospital. Early glaucoma, normal visual acuity, family support, information on medication from the pharmacist, and urban residence were positively associated with adherence.

Microperimetry as a diagnostic tool for the detection of early, subclinical retinal damage and visual impairment in multiple sclerosis

BackgroundA majority of multiple sclerosis patients experience visual impairment, often as the initial presenting symptom of the disease. While structural changes in the retinal nerve fiber layer and optic nerve have demonstrated correlations with brain atrophy in multiple sclerosis using magnetic resonance imaging, a non-invasive, cost-effective, and clinically efficacious modality to identify early damage and facilitate prompt therapeutic intervention to slow the progression of multiple sclerosis and its ocular manifestations, is still urgently needed. In this study, we sought to determine the role of macular sensitivity measured by microperimetry in the detection of subclinical multiple sclerosis-related retinal damage and visual dysfunction.MethodsThis cross-sectional observational case-control study involved population-based samples of multiple sclerosis patients and age-, race-, and gender-matched healthy control subjects. Among the key criteria for the multiple sclerosis patients were diagnosis by the McDonald criteria, visual acuity greater than 20/25, and no history of optic neuritis. Macular sensitivity and average macular thickness were measured in all subjects using microperimetry and spectral-domain optical coherence tomography, respectively. Pearson correlation coefficients were measured using bivariate correlations. Sample means, mean differences, and 95% confidence intervals were calculated using independent sample t-tests.ResultsTwenty-eight eyes from 14 MS patients and 18 eyes from 9 control subjects were included. Mean macular sensitivity of control subjects and multiple sclerosis patients in decibels was 18.2 ± 0.4 and 16.5 ± 0.4, respectively, corresponding to a mean difference of 1.7 (95% CI, 1.1–2.4; P < 0.001). Macular sensitivity was positively correlated with macular thickness in multiple sclerosis patients (r = 0.49, P = 0.01) but not control subjects (r = 0.15, P = 0.55).ConclusionsMacular sensitivity as measured by microperimetry was decreased in multiple sclerosis patients with normal visual acuity and no history of optic neuritis. Furthermore, macular sensitivity demonstrated a positive correlation with macular thickness as measured by optical coherence tomography. As such, microperimetry may represent a non-invasive and efficient method to identify signs of subclinical visual dysfunction that correspond with early macular architectural changes characteristic of multiple sclerosis.

How Our Gaze Reacts to Another Person's Tears? Experimental Insights Into Eye Tracking Technology.

Crying is an ubiquitous human behavior through which an emotion is expressed on the face together with visible tears and constitutes a slippery riddle for researchers. To provide an answer to the question “How our gaze reacts to another person’s tears?,” we made use of eye tracking technology to study a series of visual stimuli. By presenting an illustrative example through an experimental setting specifically designed to study the “tearing effect,” the present work aims to offer methodological insight on how to use eye-tracking technology to study non-verbal cues. A sample of 30 healthy young women with normal visual acuity performed a within-subjects task in which they evaluated images of real faces with and without tears while their eye movements were tracked. Tears were found to be a magnet for visual attention in the task of facial attribution, facilitating a greater perception of emotional intensity. Moreover, the inspection pattern changed qualitatively and quantitatively, with our participants becoming fully focused on the tears when they were visible. The mere presence of a single tear running down a cheek was associated with an increased emotional inference and greater perception of sincerity. Using normalized and validated tools (Reading the Eyes in the Mind Test and the SALAMANCA screening test for personality disorders), we measured the influence of certain characteristics of the participants on their performance of the experimental task. On the one hand, a higher level of cognitive empathy helped to classify tearful faces with higher emotional intensity and tearless faces with less emotional intensity. On the other hand, we observed that less sincerity was attributed to the tearful faces as the SALAMANCA test scores rose in clusters A (strange and extravagant) and B (immature and emotionally unstable) of our sample. The present findings highlight the advantages of using eye tracking technology to study non-verbal cues and draw attention to methodological issues that should be taken into account. Further exploration of the relationship between empathy and tear perception could be a fruitful avenue of future research using eye tracking.