Purpose: The purpose of this study is to measure the quality of life (QoL) in patients with glaucoma using the Glaucoma QoL-15 (GQL-15) questionnaire. Methods: A cross-sectional study with a prospective enrollment of glaucoma patients was conducted. A total of 308 patients were participated in the study. Informed consent was obtained before the administration of the GQL-15 questionnaire. The QoL was assessed using an orally administered GQL-15 questionnaire. Patients' QoL was assessed based on their age, gender, visual field (VF) defect, severity of glaucoma, laterality of disease, history of previous glaucoma surgery, and the number of antiglaucoma medications (AGMs) they were taking. Participants were divided into mild, moderate, and severe glaucoma depending on the severity of VF defects using the Hodapp–Anderson–Parrish grading system. Results: A total of 308 glaucoma patients were interviewed. The mean age of participants was 57.7 ± 12.9 years; 173 (56.1%) of them were female. The average mean deviation (MD) of the patients was 7.8 ± 4.8 dB. There were 135 (43.8%) patients with mild, 122 (39.6%) with moderate, and 51 (16.6%) with severe glaucoma. In total, 114 (37%) patients had unilateral glaucoma, whereas 138 (44.4%) patients had previous glaucoma surgery. Sixty-two (22.1%) patients did not take any AGM. The correlation coefficient between VF MD and QoL was 0.7, which was significant at 0.01 level (two-tailed). Conclusion: The findings of this study demonstrated that the severity of VF defects has a negative impact on patient's QoL.

Context: Diabetic retinopathy (DR) is an important complication of diabetes mellitus (DM). DR accounts for 4.8% of the cases of blindness throughout the world. Aims: To assess the patients' awareness about DR and their attitude and practice patterns in a tertiary care system in urban Maharashtra. Subjects and Methods: A cross-sectional study was conducted in a tertiary care hospital, Pune, Maharashtra from March 2019 to April 2020 after approval from institutional review board. Patients older than 18 years and who were diagnosed with type II DM were included. Data were entered into Excel and analyzed using the SPSS software version 20. Results: Only 28% of diabetic patients had good knowledge of DR, 82.5% were found to have positive attitude toward DR screening, and 27% had scored good in the practice score category. A significant association was found between DR knowledge with level of education (P ≤ 0.001). Conclusions: Better knowledge of DR influences a positive practice patterns in patients with diabetes. Onus lies on the healthcare professionals, particularly physicians as they are the first point of contact.

Aims: The aim of the study was to identify the risk factors and timing for the reactivation of retinopathy of prematurity (ROP) after intravitreal bevacizumab (IVB) in aggressive posterior retinopathy of prematurity (APROP). Materials and Methods: A retrospective study to analyze the outcome of 24 eyes of 12 infants treated with IVB monotherapy (0.625 mg) was done. Data were analyzed regarding the initial response to IVB, the incidence of ROP reactivation, timing, location, and stage of reactivation. Gestational age, postmenstrual age, and other neonatal comorbid risk factors were compared between the reactivation and those without reactivation after IVB. Results: The mean follow-up time was 50.2 ± 1.4 weeks after IVB. Reactivation was identified in 8 (33.3%) eyes. Reactivation in zone I was seen in only two eyes and zone II reactivation was present in six eyes. The mean postmenstrual age at the time of recurrence was 44.0 ± 1.15 weeks (range: 43–45). The mean time between initial treatment and treatment-requiring recurrence was 11.8 ± 0.9 weeks. Multiple pregnancy, low birth weight, sepsis, and necrotizing enterocolitis were significantly associated with ROP reactivation. None of our patients progressed to retinal detachment after laser treatment for reactivation. Conclusions: Although IVB treatment is effective in inducing the regression of APROP, the effect may be transient. The recurrence of ROP should be carefully watched in a long-term follow-up after IVB monotherapy, particularly in the first 12 weeks after IVB.

Introduction: Cataract with comorbidity having poor prognosis, it is important to predict visual outcome in these eyes. Materials and Methods: This was a prospective cohort study to develop scoring system to predict visual outcome in case of cataracts with comorbidities. We enrolled all cataracts with comorbidities fulfilling inclusion criteria between August 2019 and 2020. For all enrolled cases, data were collected in pretested online format in electronic medical records. A specially designed form was used to calculate preoperative score which was categorized and compared with postoperative visual outcome. All data were exported and analyzed with SPSS 22 using descriptive, cross-tabulation, and one-sample test functions. Results: Our cohort consisted of 230 eyes of 230 patients with a mean age of 44 ± 21.22 years with 121/230 (52.6%) females and 109/230 (47.4%) males. Out of total 230 eyes Traumatic cataracts were in 64, cataract with corneal opacity in 45, postuveitic cataract in 43, neglected cataracts in 39 eyes. We found a significant difference in pre- and postoperative visual outcome. When we studied preoperative score, we found a significant difference between outcomes. Conclusion: Preoperative score for cataracts with comorbidities undergoing small-incision cataract surgery SICS is a very useful tool to predict visual outcome and universalize for comparison.

Purpose: The purpose of this study was to assess the impact of the coronavirus disease 2019 pandemic imposed social distancing measures on the learning of ophthalmology in the institutions involved in the training of the ophthalmologists and the use of alternate E-learning methods to maintain the standard of education. Materials and Methods: This study was conducted among the postgraduate residents and faculty involved in ophthalmology-related education from October 15, 2020, to September 15, 2021. The study was based on a questionnaire performed based on a Google Form that was sent to the participants. Results: A total of 345 participants completed the survey. Most of the participants were using conventional learning methods such as lectures, ward rounds, clinical meets, and journal clubs. E-learning techniques showed a statistically significant increase during the pandemic (P < 0.001). Theoretical studies continued but the surgical training of the residents and fellows was significantly reduced. Conclusion: During the pandemic due to the imposed challenges in ophthalmology learning, even though surgical learning suffered, there was a significant increase in the utilization of E-learning alternatives, opening a new arena of learning opportunities.

Background: Although studies compare the accuracy of spot photoscreeners, few evaluate photoscreeners in community settings. To our knowledge, all studies from India have been purely hospital based, particularly in children under 5 years. Aim: The aim was to evaluate the effectiveness of using a commercially available photoscreener for pediatric vision screening in a community setting. Settings and Design: This cross-sectional comparative study was conducted from December 2018 to February 2019 in a north-eastern district of Delhi. Methods: The automated Spot™ Vision Screener was used to screen the vision of preschoolers. A result displayed as “complete eye exam recommended” on the photoscreener was considered as screening positive and the child was referred to the pediatric ophthalmology unit of a tertiary eyecare institution, as per predefined international guidelines. Statistical Analysis: Referral rate and positive predictive value (PPV) of using the photoscreener were considered as primary outcome measures. Results: A total of 1205 children were screened using a photo-screener. Almost 16.4% of them were identified and referred a significantly higher referral rate than that in the historic control (2.7%, P < 0.001). Nearly 51.5% of the referred children reported to the unit. The PPV of pediatric eye screening done in a community setting by the photoscreener for refractive error (RE) was 81.4%. Fifty-nine percent of the children detected with REs were found to be at risk of amblyopia. Mean spherical equivalent, sphere, and cylinder of final glass prescription were significantly different from that of photoscreener refraction. Conclusion: Photoscreener improves the referral rate and has a high PPV. It could be a standard tool to screen preschoolers in community settings.

Aims: The aim was to report the incidence and types of amblyopia in a large series of patients with intermittent exotropia at a single institution. Materials and Methods: The medical records of consecutive patients 4–30 years of age diagnosed with intermittent exotropia at our institution between January 2000 and December 2017 were retrospectively reviewed for amblyopia. Results: A total of 2,058 patients diagnosed with intermittent exotropia during the study met the inclusion criteria. Of these patients, 40 (2%) had amblyopia and were the participants of this study. The mean patient age was 10.6 ± 4.2 years. Amblyopia was anisometropic in 35 (87%) patients and strabismic in 5 (13%) patients. Of the 35 patients with anisometropic amblyopia, 29 (83%) had spherical anisometropia and 6 (17%) had astigmatic anisometropia. There was no statistically significant difference in the number of patients and the mean anisometropia between patients with spherical anisomyopic and anisohyperopic amblyopia, and also between those with astigmatic anisomyopic and anisohyperopic amblyopia. There was no relation between the type of intermittent exotropia and anisometropic amblyopia. None of the patients with strabismic amblyopia had spherical or astigmatic anisometropia but had a preference for fixation with the nonamblyopic eye. There was no statistically significant difference in near and distance deviations between patients with anisometropic and strabismic amblyopia, and between those with anisomyopic and anisohyperopic amblyopia. Conclusions: Amblyopia was observed in 2% of our patients with intermittent exotropia. It was spherical anisometropic in a large majority of patients and strabismic in a few.

Background: Rapid Assessment of Avoidable Blindness (RAAB) relies mainly on direct ophthalmoscopy (DO) for the diagnosis of posterior segment eye diseases (PSEDs). There is, however, a growing concern that DO may not be sufficiently sensitive to detect PSED owing to inherent diagnostic limitations. Aim of the Study: The aim of the study was to determine the sensitivity and specificity of DO for the detection of PSEDs in RAAB, using indirect ophthalmoscopy (IO) as a reference standard. Materials and Methods: Participants were patients 50 years and older, presenting to the eye clinic of a tertiary hospital in Jos, between April and September 2016 who gave consent. Their visual acuity was assessed as is done in RAAB6. Those found to be unilaterally or bilaterally visually impaired underwent anterior and posterior segment eye examinations to identify the cause. Dilated fundoscopy was first performed by a senior ophthalmology resident with DO (index test), followed by IO (reference standard test) by a consultant ophthalmologist. Results: A total of 250 patients were recruited into the study, of which 188 took the index and reference standard tests. PSEDs were detected in 65 (34.6%) persons and glaucoma accounted for 87.7% of these. The sensitivity of DO for the detection of glaucoma was 95.3%, while the specificity was 91.0%. Sensitivity and specificity for the detection of diabetic retinopathy and central retinal vein occlusion were both 100%. Specificity for the detection of other PSEDs was good even though sensitivity was below acceptable limits. Conclusion: The performance of DO against IO in this study, suggests that it is a satisfactory modality for the detection of the most common PSEDs in RAAB.

This is a case series of 3 patients of comitant horizontal deviations with unilateral dissociated vertical deviations (DVD) who underwent half tendon down displacement of horizontal recti during recession resection surgery. Out of these 3 patients, 2 had exotropia and 1 had esotropia. The mean horizontal deviation preoperatively was 31.6 ± 7.6 prism diopters (PD) and post-operatively was 3.0 ± 2.6 PD. Mean preoperative DVD was 11.3 ± 1.1 PD which had a near-complete resolution in all patients. No increase in DVD of the other eye was noticed in any of the patients. None of the patients required second surgery for correction of horizontal deviation or DVD. The DVD was corrected in all patients with no complications. Half tendon down displacement with recession and resection surgery of horizontal recti is effective in the correction of unilateral DVD in selected patients.

Alport syndrome is a rare disorder of abnormal type IV collagen affecting basement membranes of the glomerulus, cochlea, and ocular structures. A young male presenting with characteristic ocular signs as well as systemic manifestations of Alport syndrome. The diagnosis of Alport syndrome can be easily overlooked in patients with chronic kidney disease, unless a thorough eye examination is conducted. Genetic counseling and timely examination of patients and their families can help reduce the morbidity of the complications associated with Alport syndrome.

We report a case of post-COVID ischemic maculopathy, which has not been seen previously in COVID-associated retinal findings. The patient presented with sudden onset loss of vision following COVID infection and was treated at a local hospital. Fundus examination revealed ischemic patches interspersed with blot hemorrhages around the macula. Fundus fluorescein angiography demonstrated delayed filling of macular vessels and nonperfusion of the macula. There were signs of hyperreflectivity of the nerve fiber layer and disorganization of the inner retinal layers with foveal atrophy on optical coherence tomography. The patient responded to steroids with improvement in visual acuity. Coronavirus disease 2019 can cause vascular events such as macular infarction in healthy young people.

Myotonic dystrophy is an autosomal dominant disease which can present with various ocular manifestations. A case of myotonic dystrophy presented with limited visual recovery postcataract surgery. Multimodal imaging analysis, including fundus photography, spectral domain optical coherence tomography (SD-OCT), and fundus fluorescein angiography, were performed showing pattern dystrophy of the pigment epithelium. Fundus photography revealed mild pigmentary alteration over the macular area, whereas fluorescein angiography showed hyperfluorescent staining from the disc to macular area with intervening hypofluorescent linear streaks. On SD-OCT, an epiretinal membrane was seen over the foveal area with mild puckering of inner retinal layers. Furthermore, intraretinal hyperreflective foci were seen along with intermittently disrupted photoreceptor layer. Annual follow-up with fundus photography, SD-OCT, and fluorescein angiography is required to avoid associated complications of scarring and choroidal neovascularization. High suspicion of retinal involvement is warranted in a case of myotonic dystrophy with limited visual recovery postcataract surgery.

A 55-year-old female patient presented with no light perception and features suggestive of central retinal artery occlusion (CRAO) and posterior ciliary artery occlusion. Multimodal imaging analysis revealed retinal thickening, cherry-red spot, pallid optic disc with choroidal infarction (Amalric sign), and macular edema. Carotid Doppler disclosed 70% stenosis of the right common carotid artery. Systemic investigations showed elevated erythrocyte sedimentation rate, total cholesterol, and low-density lipoprotein level. The Amalric triangular sign with CRAO may present with macular edema. Prompt cardiac and carotid evaluation with appropriate management should be done.

A 27-year-old male presented with complaints of irritation and watering in the left eye following injury by a shrub. These symptoms subsided on rubbing the eyes and an eyewash. Slit-lamp bio-microscopy revealed an edematous cornea with vegetative foreign bodies embedded in the stroma, which were confirmed by anterior-segment optical coherence tomography. Antimicrobial therapy and immediate foreign body removal was undertaken. The patient was discharged the next day, with regular follow-ups. Foreign bodies either get embedded on the corneal surface or penetrate into the anterior chamber; it is rare for them to be retained intracorneally. The patient made a full and uneventful recovery following surgery.

Fahr's syndrome, a rare disease, is characterized by symmetrical and bilateral intracranial calcification. Here, we present the case of a 25-year-old female. She presented with progressive diminution of vision, dysarthria, and slowness of movements and had a history of seizures. Neurological examination revealed Parkinsonian features and episodes of stiffness all over the body. Right eye ultrasound-B scan and swept-source optical coherence tomography revealed optic nerve head (ONH) calcification, which is not a common finding. A computed tomography scan of the brain revealed bilateral, symmetrical, large areas of calcification over the basal ganglia, thalamus, and globus pallidus. In our patient, age and ONH calcification were two uncommon presentations.

Netarsudil (Rho-associated protein kinase inhibitor) is one of the newer anti-glaucoma medications used for the management of glaucoma. It has the most common side effects, such as conjunctival hyperemia, subconjunctival hemorrhage, and cornea verticillata. This manuscript focuses on a rarer side effect of netarsudil-associated reticular corneal epithelial edema, after netarsudil application for 3 months in a 62-year-old male. This side effect is rarely reported in the literature. In this manuscript, netarsudil-associated reversible corneal epithelial edema and its management have been reported.

We report the case of a 60-year-old female with primary angle-closure glaucoma, who presented with intraocular pressure (IOP) of 0 mmHg, significant cataract, and finger-counting vision in her left eye (LE) following high-intensity focused ultrasound (HIFU) treatment. She underwent LE cataract surgery combined with pars plana vitrectomy, membrane peeling, and silicon oil injection. Postoperatively, hypotony improved, and visual acuity improved to 20/160. One and a half years later, she underwent silicone oil removal (SOR) in view of recovered ciliary secretion and elevated IOP. Post-SOR, IOP remained elevated due to complete synechial closure secondary to prolonged hypotony and the patient is awaiting an incisional surgery. This case highlights the serious vision-threatening complications of persistent hypotony following HIFU treatment. We caution the surgeons regarding the use of HIFU in eyes with good visual potential and discuss the importance of understanding the safety and efficacy of a cycloablative procedure.

Neovascularization of the posterior capsule after uncomplicated cataract surgery is a rare occurrence. This case entails a similar presentation, however, in the absence of any known predisposition. An 80-year-old male presented with painless progressive diminution of vision in his right eye after having undergone uncomplicated cataract surgery with good visual recovery 3 years back. He had a visual acuity of counting fingers close to face with accurate projection of rays with no further improvement. He was found to have posterior capsular opacification with capsular neovascularization. He was managed with intravitreal ranibizumab followed 2 weeks later by neodymium: yttrium-aluminum-garnet capsulotomy clearing the visual axis. His visual acuity improved; however, the best-corrected visual acuity was 6/60 due to an epiretinal membrane.

Coronavirus infection most commonly presents with mild influenza-like symptoms. The most common ocular presentation is conjunctivitis. We report four patients of COVID-19 infection presenting as orbital cellulitis. They all were incidentally found COVID-19 positive on reverse transcription polymerase chain reaction. All had painful edema of eyelids, extraocular movement restriction, and other symptoms of orbital cellulitis at presentation. Three of 4 had uncontrolled diabetes and one had coronary artery disease. Proven mucormycosis was present in two patients; cerebral involvement (abscess and stroke in 1 each) in two patients. Two of them died, one underwent orbital exenteration and one developed hemiplegia due to stroke. COVID can present as orbital cellulitis and carries a very grave prognosis.

Necrotizing dacryometaplasia (ND) is a rare entity which can mimic an aggressive malignant tumor. It seems to be analogous to necrotizing sialometaplasia which generally affects the salivary glands and is an inflammatory condition. There is scarce information about this entity as only two case reports have been reported in the last two decades. Due to the presence of adjacent bony erosion, it may mimic an aggressive malignant tumor. Here, we report a 27-year-old male who presented with right upper eyelid swelling for 2 months, which clinically and radiologically pointed to be a malignancy turned out to be ND.