Unaided Visual Acuity Research Articles

Intra-orbital Foreign Body

Abstract Background: This case report describes a young man with an intra-orbital foreign body (FB) in both eyes. Case Report: Intra-orbital FBs are rare, with few cases reported in the literature. This is because the orbit protects the globe from external forces, and the orbit is a closed cavity with one opening. This report details the case of a 28-year-old man who presented to the emergency unit with an 11-hour history of an intra-orbital FB. The patient was lying on a bench when a stationary motorcycle fell on him. He noticed that he was unable to open both eyes and was rushed to a peripheral hospital, then subsequently referred to this tertiary center. On examination, he was ill-looking and anxious but not febrile or pale. Systemic examination did not reveal any abnormality. Unaided visual acuity in the right eye (OD) was nil perception of light, while left eye visual acuity (OS) was counting fingers. The right eyelid was ptotic due to edema. He underwent basic laboratory investigations that were all normal. A plain X-ray revealed a radio-opaque FB penetrating the left orbit, fracturing the medial walls into the right orbit, with the round end positioned behind the right globe. The FB was identified as a broken part of a brake/clutch lever from the motorcycle. A computerized tomography scan showed a metallic object in both orbits, accompanied by pneumocephalus, and suggested transection of the right optic nerve. The patient was prepared for FB removal and repair of the lid penetration under general anesthesia, following review by the ENT surgeon and neurosurgeon. The brake lever was successfully removed, and the patient was administered antibiotics. Post-operatively, visual acuity in the right eye remained at nil perception of light, while that in the left eye improved to 6/9 upon discharge. Conclusion: There is no established protocol for managing intra-orbital FBs, as removal depends on factors such as the size, composition, and potential compression damage to structures around the globe, which could further compromise vision or function. Small inert objects may be left in place if removal would cause damage. However, in this case, removal was deemed necessary for several reasons.

Visual outcomes following bilateral implantation of a non-diffractive extended depth of focus toric intraocular lens using a mini-monovision approach.

To evaluate the clinical outcomes following bilateral implantation of the AcrySof™ IQ Vivity™ toric extended depth of focus (EDOF) intraocular lens (IOL). Prospective interventional case series. Patients with bilateral significant cataracts and pre-existing corneal astigmatism underwent cataract surgery and implantation with the AcrySof™ IQ Vivity™ toric IOL. Dominant eyes were targeted at emmetropia and non-dominant eyes at -0.50D. Primary endpoints were binocular uncorrected distance (UDVA), intermediate (UIVA at 66cm) and near (UNVA at 40cm) acuities at 3months. Secondary outcomes were corrected distance (CDVA), distance corrected intermediate (DCIVA) and distance corrected near (DCNVA), refractive predictability, rotational stability, binocular defocus curve, contrast sensitivity, Questionnaire for Visual Disturbances (QUVID) and Visual Function Index (VF-14) questionnaire scores. All visual acuities were converted to logarithm of minimum angle of resolution (logMAR) for analysis. 30 patients underwent uneventful phacoemulsification. The mean binocular UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.11 ± 0.10 and 0.26 ± 0.10 respectively. The mean refractive spherical equivalent (MRSE) for dominant and non-dominant eyes were - 0.07D ± 0.27 and - 0.12D ± 0.54 respectively. 92.4% of dominant eyes and 84.6% of non-dominant eyes within 0.50D of target. The mean IOL rotation was 3.85° ± 5.09 with 86.7% of eyes with less than 5° of rotation. 26.7%, 20% and 36.7% of patients reported starbursts, haloes and glare respectively. The mean VF-14 score was 91.77. Bilateral implantation of the AcrySof™ IQ Vivity™ Toric IOL resulted in very good unaided visual acuities for far and intermediate distance with functional near vision. Dysphotopsias were reported but despite this, a high level of visual function was achieved.

The output of cataract surgery performed by trained non-ophthalmologist physicians in rural areas: study of cataract outcomes and up-take of services report 7.

Cataract is the leading cause of blindness worldwide and surgery can restore vision in most patients. Some patients have little access to surgical services due to lack of cataract surgeons and the unaffordable costs. In 2005 we built a service model that trained rural non-ophthalmologist physicians to perform cataract surgeries in rural China. This study evaluates the long-term impacts of this model. We conducted a retrospective cohort study to analyze patients' hand-written medical records and electronic outpatient record between January 2005 and December 2019 at two rural health clinics in Southern China. In total, 34,601 patients (49,942 eyes) underwent cataract surgery by non-ophthalmologist physicians from 2005 to 2019.Visual acuity was clearly documented in 38,251 eyes. Before surgery, the unaided distance visual acuity (UDVA) of 60.7% (23,205/38,251) eyes was less than 0.05 decimal. On the first day after surgery, the percentage of UDVA < 0.05 eyes was reduced to 6.0%, and 96.7% (36,980/38,251) of the eyes achieved a better UDVA compared to pre-operation. Surgical-related complications occurred in 218 eyes. The most common complication was posterior capsule rupture (114, 0.23%). 44.3% (15,341/34,601) of the patients chose to have a second eye cataract surgery (SECS) in the same clinic. At one of the outpatient clinics, 21,595 patients received basic eye care apart from cataract surgery between 2018 and 2020. Non-ophthalmologist physicians trained for cataract surgeries in rural clinics can improve cataract related visual acuity and basic eye care to the local population.

Optical Coherence Tomography Angiography as a Diagnostic Tool in Cystoid Macular Edema

Abstract Background Cystoid macular edema (CME) represents a common pathologic sequel of the retina and occurs in a variety of pathological conditions such as intraocular inflammation, central or branch retinal vein occlusion, diabetic retinopathy and most commonly following cataract extraction. Aim of the Work To evaluate the role of optical coherence tomography angiography in the diagnosis of cystoid macular edema. Patients and Methods We applied our study on thirty eyes will be divided into two equal groups: CME group (n = 15 eyes) and Control group (n = 15 eyes), with the same inclusion and exclusion criteria. This study included thirty eyes of twenty four patients. There were 15 patients of unilateral; while the right eye was affected in 7 patients (46.7%) and the left eye in 8 (53.3% patients in CME group; while there were 6 patients of bilateral and 3 patients of unilateral; while the right eye was affected in 7 patients (46.7%) and the left eye in 8 (53.3%) patients in control group. Results This study showed that in term of Sex, there is no statistically significant difference between the groups with p-value (p = 0.134). There was a statistically significant higher mean age in CME group compared to control group with p-value (p = 0.005). Also laterality were comparable in each of CME group were 0 patients (%) and 15 patients (100%) were bilateral and unilateral, respectively compared to control group were 6 patients (66.7%) and 3 patients (33.3%) were bilateral and unilateral respectively in term of laterality, there was a statistically significant with p-value (p = 0.002). There was a statistically significant higher mean in CME group compared to control group according to unaided visual acuity and best corrected visual acuity, with p-value (p &amp;lt; 0.001). The mean BCVA was 0.2#0.15, 0.48÷0.23, and 1.06‡0.27 log MAR for early, advanced, and severe DME. Log MAR visual acuity was significantly different among different DME grades (P &amp;lt; 0.001). There was a statistically significant higher ocular surgeries in in CME group compared to control group, with p-value (p &amp;lt; 0.001). That was a statistically significant higher OCTA findings in CME group compared to control group, with p-value (p &amp;lt; 0.001); as for the CFT there was a higher mean value in CME group was 484.2070.05 compared to 233.93=13.51, with p-value (p &amp;lt; 0.001). Conclusion In conclusion, cystoid macular edema (CME) can be identified early and OCTA can contribute to the clinical characterisation of the disease.

The Better Operative Outcomes Software Tool (BOOST) Prospective Study: Improving the Quality of Cataract Surgery Outcomes in Low-Resource Settings

ABSTRACT Purpose Post-operative vision impairment is common among patients who have undergone cataract surgery in low-resource settings, impacting quality of clinical outcomes and patient experience. This prospective, multisite, single-armed, pragmatic validation study aimed to assess whether receiving tailored recommendations via the free Better Operative Outcomes Software Tool (BOOST) app improved surgical outcomes, as quantified by post-operative unaided distance visual acuity (UVA) measured 1–3 days after surgery. Methods During the baseline data collection round, surgeons in low and middle-income countries recorded clinical characteristics of 60 consecutive cataract cases in BOOST. Additional data on the causes of poor outcomes from 20 consecutive cases with post-operative UVA of <6/60 (4–12 weeks post-surgery) were entered to automatically generate tailored recommendations for improvement, before 60 additional consecutive cases were recorded during the follow-up study round. Average UVA was compared between cases recorded in the baseline study round and those recorded during follow-up. Results Among 4,233 cataract surgeries performed by 41 surgeons in 18 countries, only 2,002 (47.3%) had post-operative UVA 6/12 or better. Among the 14 surgeons (34.1%) who completed both rounds of the study (1,680 cases total), there was no clinically significant improvement in post-operative average UVA (logMAR units ±SD) between baseline (0.50 ± 0.37) and follow-up (0.47 ± 0.36) rounds (mean improvement 0.03, p = 0.486). Conclusions Receiving BOOST-generated recommendations did not result in improved UVA beyond what could be expected from prospective monitoring of surgical outcomes alone. Additional research is required to assess whether targeted support to implement changes could potentiate the uptake of app-generated recommendations and improve outcomes.

Artificial Intelligence-Assisted Prescription Determination for Orthokeratology Lens Fitting: From Algorithm to Clinical Practice.

To explore the potential of artificial intelligence (AI) to assist prescription determination for orthokeratology (OK) lenses. Artificial intelligence algorithm development followed by a real-world trial. A total of 11,502 OK lenses fitting records collected from seven clinical environments covering major brands. Records were randomly divided in a three-way data split. Cross-validation was used to identify the most accurate algorithm, followed by an evaluation using an independent test data set. An online AI-assisted system was implemented and assessed in a real-world trial involving four junior and three senior clinicians. The primary outcome measure was the algorithm's accuracy (ACC). The ACC of the best performance of algorithms to predict the targeted reduction amplitude, lens diameter, and alignment curve of the prescription was 0.80, 0.82, and 0.83, respectively. With the assistance of the AI system, the number of trials required to determine the final prescription significantly decreased for six of the seven participating clinicians (all P <0.01). This reduction was more significant among junior clinicians compared with consultants (0.76±0.60 vs. 0.32±0.60, P <0.001). Junior clinicians achieved clinical outcomes comparable to their seniors, as 93.96% (140/149) and 94.44% (119/126), respectively, of the eyes fitted achieved unaided visual acuity no worse than 0.8 ( P =0.864). AI can improve prescription efficiency and reduce discrepancies in clinical outcomes among clinicians with differing levels of experience. Embedment of AI in practice should ultimately help lessen the medical burden and improve service quality for myopia boom emerging worldwide.

Detection of significant vision conditions in children using QuickSee wavefront autorefractor.

This study evaluated the ability of QuickSee to detect children at risk for significant vision conditions (significant refractive error [RE], amblyopia and strabismus). Non-cycloplegic refraction (using QuickSee without and with +2 dioptre (D) fogging lenses) and unaided binocular near visual acuity (VA) were measured in 4- to 12-year-old children. Eye examination findings (VA, cover testing and cycloplegic retinoscopy) were used to determine the presence of vision conditions. QuickSee performance was summarised by area under the receiver operating characteristic curve (AUC), sensitivity and specificity for various levels of RE. QuickSee referral criteria for each vision condition were chosen to maximise sensitivity at a specificity of approximately 85%-90%. Sensitivity and specificity to detect vision conditions were calculated using multiple criteria. Logistic regression was used to evaluate the benefit of adding near VA (6/12 or worse) for detecting hyperopia. A paired t-test compared QuickSee without and with fogging lenses. The mean age was 8.2 (±2.5) years (n = 174). RE ranged up to 9.25 D myopia, 8 D hyperopia, 5.25 D astigmatism and 3.5 D anisometropia. The testability of the QuickSee was 94.3%. AUC was ≥0.92 (excellent) for each level of RE. For the detection of any RE, sensitivity and specificity were 84.2% and 87.3%, respectively, using modified Orinda criteria and 94.5% and 78.2%, respectively, using the American Academy for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the detection of any significant vision condition, the sensitivity and specificity of QuickSee were 81.1% and 87.9%, respectively, using modified Orinda criteria and 93% and 78.6%, respectively, using AAPOS criteria. There was no significant benefit of adding near VA to QuickSee for the detection of hyperopia ≥+2.00 (p = 0.34). There was no significant difference between QuickSee measurements of hyperopic refractive error with and without fogging lenses (difference = -0.09 D; p = 0.51). QuickSee had high discriminatory power for detecting children with hyperopia, myopia, astigmatism, anisometropia, any significant refractive error or any significant vision condition.

Ayurvedic management of Dhumadarshi (central serous chorioretinopathy): A case report

Abstract Central serous chorioretinopathy (CSCR) is characterized by serous detachment of the neurosensory retina at the posterior pole with or without focal pigment epithelial detachment and altered retinal pigment epithelium. In most cases, treatment helps restore the vision, but no treatment could maximize the final visual gain. In Ayurveda, visual-related conditions are included in the Drishtigata Roga (diseases causing visual disturbance). CSCR based on clinical presentation can be categorized under Dhumadarshi. A 42-year-old female came to the outpatient department of Shalakya tantra with the complaint of dimness in vision in the left eye (OS: oculus sinister) for 2 days, along with a black spot in the center of her vision while walking. On examination, unaided distant visual acuity was 6/36 in the left eye (OS) and 6/9 in the right eye (OD: oculus dexter). On optical coherence tomography examination, it was diagnosed as a case of CSCR. Interventions included in this study were on an outpatient basis with the potential action of Shothahara (anti-inflammatory), Vatanulomana (pacification of obstructed Vata), Medhya (intellect enhancer), and Drishtiprasadana (enhancing eyesight). At the end of the consultation, the vision was restated to normal, and the accumulation of subretinal fluid was completely resolved. In conclusion, Ayurvedic intervention can aid in accelerating visual restoration and reducing accumulation of subretinal fluid.

BARRAGE LASER PHOTOCOAGULATION IN HIGH-MYOPIC PATIENT WITH SYMPTOMATIC RETINAL TEARS BEFORE PHACOEMULSIFICATION: A CASE REPORT

Introduction : Retinal tears can be present in up to 2.4% of cases of lattice degeneration, which is considered an important risk of retinal detachment in a high-myopic patient. Laser photocoagulation has been shown to reduce the risks of retinal detachment before phacoemulsification thus improve in the visual outcome. We report a case of a high myopic patient with symptomatic retinal tears who underwent phacoemulsification that was treated prophylactically with barrage laser photocoagulation.&#x0D; Case Illustration : A 43 years-old female with a history of high myopia complained of flashes and floaters on both eyes. She had high myopia measuring -13.0 dioptres and -28.0 dioptres in the right and left eyes respectively. Unaided visual acuity was 2/60 in both eyes. Fundus examination showed lattice degenerations with a small tear found on both eyes with no retinal detachments. She was treated with a barrage laser on both eyes followed by phacoemulsification. On the last follow-up, the retina remained stable and the visual acuity was significantly improved with no development of macular edema or retinal detachment in both eyes.&#x0D; Discussion : Although most cases of lattice degeneration do not need intervention, some present a risk of retinal detachment. Barrage laser photocoagulation may have a place in high myopic patient lattice degeneration with symptomatic retinal tears to maintain retinal stability and to obtain the optimal outcome after phacoemulsification.&#x0D; Conclusion : Barrage laser photocoagulation is beneficial as a prophylactic treatment of symptomatic retinal tears before phacoemulsification in high-myopic patients.

Spectacles Under Utilization and Associated Factors Among Adults in Hawassa, South Ethiopia, June, 2022.

The commonest and cheapest treatment modality for correcting refractive error is spectacles or eyeglasses. In Ethiopia, the rate of spectacles under utilization and its impact on visual impairment was not known. To assess spectacles under utilization and associated factors among adults in Hawassa, Ethiopia, 2022. Community-based cross-sectional study design was conducted from Jan 2021 to May 2022 with a final sample size of 664. Multi-stage random sampling technique was used during the sampling process. Using an interviewer-based questionnaire, the selected individuals were asked about demographic characteristics, spectacles use, and satisfaction with spectacles, knowledge, and attitude about spectacles. An odds ratio with a 95% CI was used to display the results. A P-value less than 0.05 in multivariate logistic regressions is used to show statistical significance. The prevalence of spectacles under utilization was 307 (48.7%). The spectacles under utilization was more prevalent in individuals with unaided visual acuity of 6/6 -6/12 (46.1%), no eye checkup (38.4%), no surgery on the eye (46.6%), willingness to accept spectacles (35.9%), good knowledge about spectacles (32.6%) and poor attitude about spectacles (35%). The most common reasons for not utilizing spectacles were believed not necessary (14.9%), expensive cost (13.1%), and discomfort (11.4%). Among the spectacles users (33.64%) who wore spectacles for 2 years, 31.17% procured the spectacles without physician orders and 46.6% purchased the spectacles in the optical workshop. The most common purpose to use spectacles was for protection (41.4%). The spectacles under utilization in Hawassa town was high. Rural residency, occupation, eye check, eye surgery, no willingness to wear spectacles, and attitude towards spectacles were significantly associated with spectacles under utilization. It is necessary to provide health education to improve the poor attitude regarding spectacles and eye checks.

Quantitative analysis of optic disc changes in school-age children with ametropia based on artificial intelligence.

To explore changes in the optic disc and peripapillary atrophy (PPA) in school-age children with ametropia using color fundus photography combined with artificial intelligence (AI) technology. Based on the retrospective case-controlled study, 226 eyes of 113 children aged aged 6-12y were enrolled from October 2021 to May 2022. According to the results of spherical equivalent (SE), the children were divided into four groups: low myopia group (66 eyes), moderate myopia group (60 eyes), high myopia group (50 eyes) and emmetropia control group (50 eyes). All subjects underwent un-aided visual acuity, dilated pupil optometry, best-corrected visual acuity (BCVA), intraocular pressure, ocular axis measurement and color fundus photography. The width of PPA, horizontal diameter ratio of PPA to the optic disc and area ratio of PPA to the optic disc were significantly different among the four groups (P<0.05). The width of the nasal and temporal neuroretinal rim, the roundness of the optic disc, the height of PPA, the vertical diameter ratio of PPA to the optic disc, and the average density of PPA in the high myopia group were significantly different compared with the other three groups (P<0.05). There were strong negative correlations between SE and area ratio of PPA to the optic disc (r=-0.812, P<0.001) and strong positive correlation between axial length (AL) and area ratio of PPA to the optic disc (r=0.736, P<0.001). In school-age children with high myopia, the nasal and temporal neuroretinal rims are narrowed and even lost, which have high sensitivity. The area ratio of the PPA to the optic disc could be used as an early predictor of myopia progression, which is of great significance for the development prevention and management of myopia.

Prevalence of visual impairment, uncorrected refractive errors and effective refractive error coverage in Koshi Province, Nepal - Rapid Assessment of Refractive Errors.

To determine the prevalence of visual impairment (VI), uncorrected refractive errors (URE), and effective refractive error coverage among individuals aged 15-50 years in Koshi Province, Nepal. A population-based cross-sectional study was conducted in Koshi Province in which 4800 participants were selected from 80 clusters. The study teams visited the selected households and conducted eye examinations. This included monocular unaided (and aided) visual acuity assessment using a Snellen chart with tumbling E optotypes at a distance of 6 meters. Near vision was assessed binocularly using the N notation chart at a fixed distance of 40 cm for each individual. Torchlight examination and distance direct ophthalmoscopy was done. VI was defined as presenting visual acuity worse than 6/12 in the better eye. URE was defined as presenting visual acuity worse than 6/12 and improving to 6/12 or better on using a pinhole. Near Vision Impairment was defined as binocular presenting near vision worse than N8 among those age 35 years and older. In total, 4057 were examined (84.5% response rate). The prevalence of VI was 3.52% (95% CI:2.89-4.13; n = 143). The prevalence of URE in the better eye was 1.95% (95% CI:1.54-2.42; n = 79). The Refractive Error Coverage and Effective Refractive Error Coverage were 34.8% and 31.3% respectively. The prevalence of NVI was 34.24% (95% CI: 32.1-36.40; n = 666). The prevalence of VI and URE was low, attributed to the availability and uptake of services in Koshi province in Nepal.

Quality of Vision and Ocular Higher Order Aberrations after SMILE for Myopia and Myopic Astigmatism

Background Previous studies have shown considerable amounts of higher order aberrations following SMILE. In our study we aim at accurately quantifying the higher order aberrations following SMILE in myopia and myopic astigmatism. Objective To detect the effect of SMILE on quality of vision and the incidence of higher order aberrations following SMILE. Patients and Methods This is a prospective study that included 30 eyes of 18 patients presented in the outpatient clinic seeking advice for myopic refractive surgical correction. The study was conducted in accordance with the ethical standards stated by the ethical committee of Ain shams university hospitals with informed consents obtained from all participants. Results On studying the post-operative corneal third order aberrations we detected increase in post-operative vertical and horizontal coma, and spherical aberrations with non-significant change in vertical and horizontal trefoil. According to our study results, SMILE is an effective refractive surgery that improves visual acuity. That causes decrease in quality of vision through modulation transfer ratio and increase in ocular higher order aberrations. Conclusion SMILE (small incision lenticule extraction) is an efficient modality for refractive surgical correction of myopia and myopic astigmatism, with significant post-operative improvement in unaided visual acuity detected post-operative increase in the ocular HOAs. Total coma, trefoil and sphere increase significantly in mesopic more than photopic pupil. The degree of myopia didn’t affect the ocular higher order aberrations except for modulation transfer ratio.

Unilateral Purtscher’s retinopathy – A rare case report

With retinal whitening (Purtscher’s flecken) and intraretinal hemorrhages, Purtscher’s retinopathy was initially reported as a symptom of sudden loss of vision following head trauma in 1910. A 28-year-old male patient presented with a history of sudden painless decrease of vision in his left eye (LE) for 1 week. He gave a history of head-and-neck injury following a road traffic accident. Unaided distance visual acuity was 20/20 in the right eye (RE) and 20/40 in the LE which improved up to 20/25 on pinhole at the time of presentation. On examination, the anterior segment was within normal limits. Fundus photo and ocular coherence tomography (OCT) showed normal in the RE; however, LE showed multiple white patches around the optic disc with flamed-shaped hemorrhages on the fundus photo and macular edema with discontinuity in the inner and outer retinal layer on OCT. The patient received oral steroids as treatment, and after 1 month of follow-up, had recovered to 20/20 visual acuity.

Visual Outcomes, Quality of Vision, Patient Satisfaction and Spectacle Independence After Bilateral Implantation of the Synergy™ Intraocular Lens.

To evaluate vision, visual quality, patient satisfaction and spectacle independence after bilateral implantation of the TECNIS Synergy™ intraocular lens. Two clinical practices in the USA. Ambispective unmasked non-randomized clinical trial. Patients with a history of uneventful bilateral femtosecond laser assisted cataract surgery with the study IOL implanted, targeted for emmetropia, at least 3 months prior to the study visit were enrolled. Monocular and binocular visual acuity (VA) were measured at distance, intermediate and near, along with binocular mesopic VA. Low contrast binocular VA and reading speed in mesopic and photopic conditions were also measured. Patient satisfaction, spectacle independence, visual symptoms, and functional vision questionnaires were completed. Results from 52 subjects were available for analysis. Mean binocular unaided visual acuity was ~0.1 logMAR (20/20) from distance to 33 cm, with 81% of subjects having 0.2 logMAR (20/25) vision or better at all test distances and 92% reporting never needing glasses at any distance. Average reading speed at 40 cm was only 10 words/minute slower in dim light (p = 0.03). Mesopic and low contrast acuity appeared good. Halos were the most frequent and bothersome visual disturbances, with the greatest effect on driving at night. Eighty-eight percent of subjects reported being "completely" or "mostly" satisfied with their overall unaided vision. This hybrid technology IOL provided a range of binocular visual acuity from distance to 33 cm and good functional vision, even in dim light. Patients should be advised of the likelihood of visual disturbances, particularly halos.

Keratoconic patient profile and management at public sector facilities in South Africa

Background: Keratoconus (KC) is a condition marked by thinning and protrusion of the cornea resulting in high myopia and irregular astigmatism. Knowledge of KC patients’ profiles and management approaches used can help to predict the needs of public hospitals to improve patient care.Aim: This study aimed to describe the profiles and management of KC patients.Setting: Capricorn district, Limpopo Province, South Africa.Methods: Medical records of 188 KC patients attending public hospitals of Capricorn District from January 2017 to December 2020 were reviewed. Data on patient profile and their management were collected and analysed.Results: The mean age of KC patients was 20.64 ± 6.82 years and the majority (56.9%) were males. Clinical findings were mean unaided visual acuity (UVA) of 0.19 ± 0.18, best corrected VA of 0.53 ± 0.24, spherical equivalence of -4.89 ± 9.17 dioptre (D), mean K of 57.37 ± 17 D and corneal astigmatism of -6.24 ± 4.27 D. A total of 54.5% of patients had severe KC. Bilateral KC was found in almost all patients (97.3%) and a mean K difference of 7.59 ± 6.08 D (p 0.001) between the better and the worse eye. The study found no significant difference in KC severity by age (p = 0.451) and gender (p = 0.819). Patients fitted with scleral lenses had the highest VA improvement of 0.44 ± 0.17.Conclusion: Most patients presented with bilateral and severe KC. Scleral lenses provided higher VA improvement than other methods.Contribution: The study aimed to present the clinical profile and management of keratoconic patients attending public sector facilities. Knowledge of the patterns of KC presentation may assist in the development of intervention strategies and guidelines for best practice in the management of KC, especially in public sector facilities.

Impact of practicing internal benchmarking on continuous improvement of cataract surgery outcomes: a retrospective observational study at Aravind Eye Hospitals, India

ObjectiveWe aim to assess the effectiveness of a cataract surgery outcome monitoring tool used for continuous quality improvement. The objectives are to study: (1) the quality parameters, (2) the monitoring...

A comparative study on slow down progression of myopia using atropine 0.01% in children

The aim of the study was to determine the efficacy of lower concentration of Atropine 0.01% in promoting unaided visual acuity and slowing down the progression of myopia in children over 6 months. It was a hospital-based comparative study in the outpatient department of Ophthalmology, AL, LT, ACD, PPD, SPD, PGP were taken by Lenstar and Lensometer.The Comparative study was performed on 60 children from 9 to 15 years age group with initial myopic spherical equivalence from 0.5 to 6.00 D. The children were screened for visual acuity for distance and near using Snellen’s chart. Cycloplegic Refraction was done to know the presence of Refractive Errors. This study was approved by IRB Ethical Committee. (SCAHS/IRB/2022/JULY/420).The inclusion criteria include Ammetropic children with no binocular vision anomalies and no history of ocular disease. The primary outcome was the rate of myopic progression after 6 months. The participants were instructed to use Atropine 0.01% eye drops during night times for 6 months and the rate of myopic progression and the spherical equivalence, axial length, lens thickness, anterior chamber depth, photopic and scotopic pupil diameter were re-assessed to compare the progression of myopia in the children. Sixty children enrolled for six months study in which the mean progression of myopia was found to be within 0.27D and axial elongation shows 0.23 mm changes respectively, whereas there were no significant changes in the anterior chamber depth, lens thickness, photopic and scotopic pupil diameter before and after assessment in children. Spherical power, Axial Length, Anterior Chamber Depth, Lens Thickness, Photopic Pupil Diameter and Scotopic Pupil Diameter all showed significant progression from pre to post stages, with the average post reading deviating by 0.25 from the normal limits.

Orthokeratologie bei Hyperopie und Presbyopie – ein Fallbeispiel

Purpose. The aim of this case report is to describe accelerated orthokeratology for hyperopia and associated presbyopia with a customized contact lens. Material and Methods. Four-curve, spherical, reverse contact lenses were fitted with the assistance of topography, simu- lation of the fluorescein pattern of the first contact lens, and analyses from the orthokeratology literature. Fitting success was determined by comparing results before the first night and after the thirtieth night after orthokeratology. Results. After thirty nights of orthokeratolgy the best unaid- ed visual acuity for distance was 1.0 and for near 0.63. The dioptric power of the corneal surface was comparable with the dioptric power of a multifocal simultaneous contact lens. The success of unaided visual acuity could not completely explained by the corneal dioptric power. Orthokeratology in hyperopia was comfortable and without pathological changes on the cornea. Conclusion. Customized reverse spherical orthokeratology contact lenses could compensate hyperopia and associated presbyopia. Keywords Orthokeratology, hyperopia, presbyopia, reverse contact lens

A clinical trial on phakic intraocular lens for the treatment of refractive amblyopia in children and adolescents.

To analyze the demographics and clinical outcomes of posterior chamber phakic intraocular (IOL) implantation for refractive amblyopia in children and adolescents. A prospective interventional study was performed on children and adolescents with amblyopia at a tertiary eye care center from January 2021 to August 2022. Twenty-three eyes of 21 anisomyopic and isomyopic amblyopia patients operated for posterior chamber phakic IOL (Eyecryl phakic IOL) as a treatment for amblyopia were included in the study. Patient demographics, pre- and postoperative visual acuity, cycloplegic refraction, anterior and posterior segment examination, intraocular pressure, pachymetry, contrast sensitivity, endothelial count, and patient satisfaction scores were evaluated. Patients were followed up at day 1, 6 weeks, 3 months, and 1 year after surgery, and visual outcomes and complications were documented. The mean age of patients was 14.16 ± 3.49 years (range: 10-19 years). The mean intraocular lens power was - 12.20 diopter spherical (DS) in 23 eyes and - 2.25 diopter cylindrical (DC) in four patients. The mean unaided distant visual acuity (UDVA) and best-corrected visual acuity (BCVA) were 1.39 ± 0.25 and 0.40 ± 0.21 preoperatively on the log of minimum angle of resolution (logMAR) chart. Postoperatively, the visual acuity improved by 2.6 lines in 3 months period and maintained till 1 year. Postsurgery, contrast sensitivity in the amblyopic eyes significantly improved, and the average endothelial loss recorded was 5.78% at 1 year, which was statistically insignificant. Patient satisfaction score was statistically significant, with 4.736/5 recorded on the Likert scale. Posterior chamber phakic IOL is a safe, effective, and alternative method for treating amblyopia patients who are noncompliant with glasses, contact lenses, and keratorefractive procedures.