A compressive assessment of patient satisfaction with ophthalmology with ophthalmology clinic services: A study at a tertiary care academic institution amidst and after the COVID-19 pandemic.

PURPOSE: The study aims to systematically assess patient satisfaction concerning eye care services provided during and after the coronavirus disease 2019 (COVID-19) pandemic at a tertiary care academic institution. This work seeks to analyze the various dimensions influencing the holistic measure of overall patient contentment. METHODS: A cohort of 2485 patients seeking physical consultation for ocular conditions at a tertiary care academic institution between April 2020 and December 2022 were recruited in a cross-sectional study. They were divided into two groups, viz. during the COVID period and post-COVID period. The primary focus was on evaluating overall satisfaction, measured through a validated patient satisfaction questionnaire (PSQ-18). RESULTS: The study encompassed a total of 2485 participants, with 1242 individuals in the cohort during the COVID period and 1243 in the post-COVID phase. Within the COVID period subgroup, the mean age of male and female patients was 39.46 ± 19.31 and 39.58 ± 19.07 years, respectively. In the post-COVID subgroup, the mean age of male and female patients was 45.26 ± 19.38 and 45.36 ± 19.22 years, respectively. Examining the COVID subgroup, the highest satisfaction scores were observed in the domain of time spent with the doctor (3.3453 ± 0.59), followed by financial aspects (3.0816 ± 0.47), interpersonal manner (3.0589 ± 0.37), and accessibility and convenience (3.0585 ± 0.37). Notably, technical quality received the lowest satisfaction score (2.4763 ± 0.42). A statistically significant difference ( P < 0.0001) was noted in the PSQ-18 scores between the two groups. In the post-COVID subgroup, patients expressed higher satisfaction with the technical quality of treatment, irrespective of the mode of management. However, financial satisfaction was better in the COVID group. CONCLUSION: Our study using the PSQ-18 questionnaire highlights significant variations in patient satisfaction with ophthalmology clinic services during and after the COVID era. Notably, time spent with the doctor scored the highest, emphasizing its positive impact. However, addressing concerns related to technical quality is crucial for overall improvement.

Assessment of glaucoma severity and deterioration by using Spaeth/Richman contrast sensitivity (SPARCS) and its correlation with retinal nerve fiber layer thickness and perimetry.

PURPOSE: To assess the severity of glaucoma and its worsening using Spaeth/Richman contrast sensitivity (SPARCS). To evaluate its correlation with retinal nerve fiber layer thickness (RNFL) and perimetry. METHODS: In this prospective observational study, 90 eyes of primary open-angle glaucoma were categorized into mild, moderate, and severe glaucoma (30 each). All eyes were subjected to contrast sensitivity measurements by using the Pelli-Robson (PR) chart and SPARCS, Humphrey automated perimetry, and optical coherence tomography (OCT) RNFL, along with routine ophthalmological evaluation at baseline. Contrast sensitivity was repeated at 1, 3, and 6 months. Other investigations were repeated at 6 months. The correlation between contrast sensitivity and other parameters was analyzed at baseline and 6 months. RESULTS: Total SPARCS showed a significant positive correlation with visual field index, pattern standard deviation, mean deviation, OCT RNFL, and a negative correlation with best corrected visual acuity. Central SPARCS and PR scores exhibited strong positive correlations. Both total and quadrantic SPARCS significantly reduced from mild to moderate to severe glaucoma. The quadrant-wise SPARCS also correlated well with opposite-side RNFL thickness. At 6 months, SPARCS showed a significant reduction along with RNFL measurements preceding any significant changes in visual field parameters. CONCLUSION: This study establishes SPARCS as a reliable and reproducible tool in assessing the deterioration of visual function in glaucoma patients even before significant perimetric changes. The specific relationship of quadrantic SPARCS with opposite-side RNFL is a novel yet expected finding. The findings advocate integrating SPARCS into routine glaucoma assessment for timely detection of any worsening and prompt intervention, improving the visual outcomes in these patients.

Insights Into Ocular Resilience: Unraveling the Epidemiology, Prognostic Factors, and Visual Triumphs of Open Globe Injuries in the COVID-19 Era at a Leading Tertiary Care Centre of Western Rajasthan, India.

INTRODUCTION: This study was conducted to describe the epidemiology, prognostic factors, and visual outcomes of open globe injuries (OGIs) at a tertiary care centre in Western Rajasthan, India. METHODS: Data of OGI patients treated at the Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, from March 2019 to December 2021 were reviewed retrospectively. Demographic details including age, gender, place of injury, wound characteristics (i.e., cause, mechanism, location, and size), visual acuity (VA), and associated ocular injuries were recorded. The Ocular Trauma Classification System (OTCS) and the Birmingham Eye Trauma Terminology (BETT) were used to categorize OGIs. All the data was entered into a Microsoft Excel sheet (Microsoft Corporation, Redmond, Washington, United States) and analyzed with IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). RESULTS: A total of 40 patients with OGIs were included. OGI was discovered to be four times higher in males and 47.5% of the total cases were observed in patients aged 0-15 years, followed by patients aged 16-30 (27.5%). The rupture injury showed a higher incidence rate (32.5%) than the penetrating injury (62.5%). Of all OGIs, 75% were grade 4 injuries, with zone 1 being the most often affected zone and wood stick injury being the most prevalent aetiology. A significant difference was noted (p<0.001) in comparing presenting VA with final VA with paired sample t-test. A negative Spearman correlation was noted between age and final VA (r = 0.53, p = 0.000), and the grade of injury and final VA (r = 0.51, p = 0.001.) Conclusion: Young males were the most susceptible group to sustain OGIs due to their more physical activities. Health education and safety in the workplace and during sports are crucial to reduce the incidence of OGI.

Analysis of foveal avascular zone by using spectral-domain optical coherence tomography angiography in healthy Indian eyes.

PURPOSE: To analyze FAZ superficial (s) and deep (d) area and dimensions by using spectral-domain optical coherence tomography angiography (OCTA) in healthy eyes and to assess effect of age, gender, axial length (AL), central foveal thickness (CFT), and central choroidal thickness (CCT) on FAZ. We aimed to study FAZ dimensions with OCTA in healthy Indian eyes with the purpose of creating a normative database. SETTINGS AND DESIGN: Observational cross-sectional study. METHODS: In total, 200 healthy eyes in the age group of 20-60 years having best corrected visual acuity better than 6/12 (Snellen's) with no systemic illness/intraocular surgery were included. FAZ parameters were calculated using OCTA, and the same was evaluated for any correlation with different ocular parameters mentioned above. The data were reported as frequencies/percentages and mean ± SD. The association between quantitative variables was evaluated using Pearson's correlation coefficient. RESULTS: The dFAZ area (0.56 ± 0.12 mm 2 ) was larger than the sFAZ area (0.42 ± 0.13 mm 2 ). Females had larger FAZ than males. AL and CFT had a negative correlation, whereas CCT had a positive correlation with FAZ. Age did not influence FAZ. sFAZ and dFAZ varied significantly in healthy eyes. CONCLUSION: FAZ parameters calculated using OCTA in healthy Indian eyes suggested that the area and dimensions in both SCP and DCP are larger in individuals from the Indian subcontinent when compared to other parts of the world. FAZ area and dimensions, when compared to previous studies, were variable. Thus, there is a need to establish normative data for ethnicity for proper interpretation of FAZ using OCTA.

Ocular surface changes in primary open-angle glaucoma on anti-glaucoma medications versus treatment-naïve patients.

PURPOSE: To examine the ocular surface disease in primary open-angle glaucoma (POAG) patients already on treatment versus POAG patients without treatment. METHODS: A prospective cohort study was conducted on 120 eyes of 60 POAG patients: 60 treatment-naïve eyes (group I) and 60 eyes already on topical anti-glaucoma medications (AGMs) (group II). All patients had filled out the Ocular Surface Disease Index (OSDI) questionnaire and underwent a comprehensive glaucoma workup. Tear break-up time (TBUT) test, Schirmer's test (type I), corneal sensitivity, anterior segment-optical coherence tomography (AS-OCT), and corneal and conjunctival staining were done at day 1, 1 month, 3 months, 6 months, and 12 months follow-up. RESULTS: On presentation, TBUT, Schirmer's test, tear meniscus height (TMH), and tear meniscus depth (TMD) were significantly higher in group I compared to group II. No significant difference was noted in OSDI score, corneal sensitivity, and tear meniscus area (TMA) between the groups on presentation. Both, lissamine green and rose bengal staining, had higher grades in group II compared to group I. Worsening of ocular surface disease was noted in both groups on follow-up. OSDI score, TBUT, Schirmer's test, TMH, and TMD had better values in group I in comparison to group II on follow-up. CONCLUSION: The study has identified glaucoma patients on AGMs to be more affected by dry eye disease (DED) compared to treatment-naive glaucoma patients. We found statistically significant differences in values of TBUT, Schirmer tests, lissamine and rose bengal staining, and AS-OCT parameters at baseline and 3, 6, and 12 months follow-up. OSDI scores showed significant differences at 6 and 12 months of follow-up. We recommend consideration of evaluation and management of DED/ocular surface disease in glaucoma patients on topical AGMs, particularly multiple drugs and doses.

Optical Coherence Tomography Angiography Parameters of the Retina in SARS-CoV-2 Recovered Subjects.

INTRODUCTION: This study aims to evaluate retinochoroidal optical coherence tomography angiography (OCTA) parameters in patients recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This study was an observational study that included 80 subjects being discharged after having negative reports on the reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2 to evaluate OCTA parameters of the retina. The subjects underwent an ophthalmic evaluation that included best-corrected visual acuity (BCVA), intraocular pressure (IOP), color vision (CV), contrast sensitivity (CS), and optical coherence tomography (OCT) parameters. OCTA was done for all patients and was evaluated for foveal avascular zone (FAZ) area, perimeter, and circularity index, and vessel density (VD) in superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR), outer retina chorio-capillaries (ORCC), chorio-capillaries (CC), and choroid (C) using 3 x 3 mm scans. The OCTA parameters were compared with normative data of the Indian population for various parameters in question. RESULTS: The subjects included 54/80 (67.5%) males and 26/80 (32.5%) females having a mean age of 52.40 ± 15.71 (18-60) years. The systemic evaluation revealed 38.75% of subjects had hypertension, 30% had diabetes, 20% had kidney disease, 5% had tuberculosis, and 3.75% had coronary artery disease. The mean distance BCVA was logarithm of the minimum angle of resolution (LogMAR) (1.17 ± 0.22), mean IOP was 17.0 ± 4.0 mmHg, mean CS was 2.13 ± 0.36, 50.62% of subjects had normal CV on Farnsworth test while 47% had tritanopia, and none of the subjects had red-green CV defect on Ishihara plates. The OCT scan was normal in 90% of eyes while the posterior vitreous detachment was seen in 4% of eyes, broad vitreomacular adhesion in 2.5% of eyes, and the globally adherent epiretinal membrane was seen in 2.5% of eyes. The mean central macular thickness (CMT) measured 245.14 ± 28.41 micrometers. The mean FAZ area measured 0.37 ± 0.15 mm2, the perimeter was 3.28 ± 1.08 mm, and the circularity index measured 0.41 ± 0.10. The average VD in SCP measured 16.06 ± 12.29, in DCP measured 9.11 ± 8.75, in OR measured 6.38 ± 7.37, in ORCC measured 42.53 ± 12.46, in CC measured 25.83 ± 16.31, and in C measured 25.52 ± 17.49. The VD in coronavirus disease 2019 (COVID-19) subjects was significantly lesser than that in the healthy Indian population in all layers except ORCC. CONCLUSIONS: The SARS-CoV-2 recovered subjects have a reduced VD in retinochoroidal layers from COVID-19, an underlying systemic disease, or both. The CS values fall within normal limits. Several subjects show tritanopia on the Farnsworth test but no red-green CV defect on Ishihara plates.

Coexistent Rosai Dorfman disease and Langerhans cell histiocytosis in an Orbital mass: A Case Report.

INTRODUCTION: Rosai Dorfman disease (RDD) is a rare benign histiocytic proliferative disorder of lymph node sinuses. Langerhans cell histiocytosis (LCH) is a solitary or multisystem clonal proliferation of abnormal dendritic cells (Langerhans cells) with varied presentations. The co-occurrence of these two entities is quite rare. CASE DESCRIPTION: A six-year-old boy presented with multiple mass lesions in the neck since two years and a nodular lesion in right upper eyelid for the past 4 months. He was diagnosed with tubercular lymphadenitis 2 years back, and was given a course of anti-tubercular therapy (ATT) elsewhere. No improvement was seen. Fine needle aspiration cytology (FNAC) of the cervical lymph nodes revealed reactive lymphadenitis while lymph node biopsy showed features of RDD. Excision biopsy of the orbital mass showed features of both RDD and LCH. The patient was started on tablet prednisolone. Six months later, complete resolution of lymph node enlargement and remaining orbital mass was noted. Post operative contrast enhanced Magnetic Resonance Imaging of head and neck was normal. CONCLUSION: The coexistence of RDD and LCH may be a result of divergent differentiation from a common lineage or a de novo phenotypic evolution.

Comparative Evaluation of Intraocular Lens Power Calculation Formulas in Children.

Introduction With the advent of newer microsurgical techniques, the results for cataract surgery have become quite promising. An accurate intraocular lens (IOL) power calculation is one of the most important factors in optimizing the results. The aim of this study was to evaluate the accuracy of four IOL power calculation formulas, namely, Barrett Universal II, Holladay 1, SRK/T and Hoffer Q, using optical biometry in children undergoing cataract surgery with primary IOL implantation. Methods This was a cross-sectional study. A total of 60 eyes of 42 children aged 5-16 years with congenital cataract and having undergone uneventful cataract surgery with IOL implantation were included in the study. Eyes were divided into three groups based on the axial length (AL): short (AL <22.00 mm), medium (AL 22-24.50 mm) and medium long (AL 24.50-26.00 mm). Optical biometry was used and the IOL power was calculated using the Barrett Universal II formula. The predicted postoperative refraction with the other three formulas, namely, SRK/T, Holladay 1 and Hoffer Q, using the same IOL power was estimated. This was compared with the actual postoperative refraction (spherical equivalent at 12 weeks) to give the absolute prediction error. The mean of all absolute prediction errors gave the mean absolute prediction error (MAE) values for each formula that were then compared. Results The MAE was 0.64 ± 0.73 for Barrett Universal II, 0.7 ± 0.72 for Holladay 1, 0.71 ± 0.65 for Hoffer Q and 0.8 ± 0.75 for SRK/T. Thus, Barrett Universal II had the lowest MAE across the whole group. The difference in the MAEs was not statistically significant. Conclusion Barrett Universal II had the lowest MAE and thus was predictable for the highest number of eyes in our study, although this was not statistically significant (p=0.176).

Assessing contrast sensitivity change in retinal diseases with use of yellow-amber NoIR glasses.

Purpose: The purpose of this study was to assess change of contrast sensitivity (CS) in subjects having retinal diseases with yellow-amber no infrared (NoIR) glasses used as low vision aid (LVA). Methods: We examined CS in 82 low vision (LV) subjects having retinal diseases with Pelli Robson Chart at 1 m distance before and after wearing yellow-amber NoIR glasses. We also found type of retinal affection and macular optical coherence tomography (OCT) features. Results: The distance and near best-corrected visual acuity (BCVA) was, respectively, 0.68 ± 0.17 (median = 0.70) and 0.72 ± 0.25 (median = 0.70) logmar units. The pre-LVA CS was 0.52 ± 0.29 (median = 0.3) and post- LVA was 0.52 ± 0.28 (median = 0.45) logunits (mean reduction = -0.002 ± 0.24; Median reduction = 0; P = 0.909). The pre-LVA and post-LVA CS showed a negative correlation with logmar distance BCVA [r = -0.090; P = 0.317 and r = -0.152; P = 0.090 respectively]. The pre-LVA and post-LVA CS showed a negative correlation with logmar near BCVA [r = -0.114; P = 0.207 and r = -0.054; P = 0.549 respectively]. The CS did not improve in subjects having macular degeneration, pathological myopia, hereditary maculopathy, and diabetic retinopathy. The macular OCT features like fluid, exudates, scars, drusens, traction, and hole did not significantly influence CS both at pre-LVA and post-LVA stage. Conclusion: This is the first study with yellow-amber NoIR glasses which blocks "both ultraviolet and infrared light." The subjects having macular degeneration, pathological myopia, hereditary maculopathy, and diabetic retinopathy did not improve in CS with filters. The correlation values showed that filters may improve CS in subjects having good baseline BCVA.

Ocular surface response to fibrin sealant versus vicryl suture for conjunctival closure after strabismus surgery: An objective assessment.

PURPOPSE: This study aims to evaluate the ocular surface response after strabismus surgery, using two different materials for conjunctival closure. METHODS: Randomized prospective comparative study was done. After performing strabismus surgery, conjunctival flap was apposed with fibrin sealant in Group 1 and 8-0 vicryl suture with buried knots in Group 2. Preoperative and postoperative measurement of tear film break up time and Schirmer test for tear secretion was done in both the groups of 30 patients each at regular follow-up visit up to 2 months. Postoperatively, both the groups were also compared for the resolution of discomfort and redness. RESULTS: Conjunctival recession was not seen in any group. Mean period was 5.8 days for resolution of discomfort (pain, lacrimation, and irritation) and 7.2 days for redness in Group 1 compared to 12 and 16 days in Group 2 (P < 0.05). During the study, we noticed significant decrease in tear film stability and increase in tear secretion in both the groups. However, in Group 2, the parameters were significantly more altered and even changes persisted for longer duration. CONCLUSION: Early rehabilitation of ocular surface might be related to unaltered healing process with the use of a biological substance (fibrin sealant) as compared to suture.

Bilateral Phacomatosis Pigmentovascularis in a Young Male with Developmental Glaucoma and Varicose Veins.

AIM: To report a case of bilateral phacomatosis pigmentovascularis (PPV), in a young male,presenting with developmental glaucoma and high myopia along with systemic features of klippel trenanauy weber (KTW) syndrome. BACKGROUND: The co-existence of oculodermal melanocytosis (ODM)and port-wine stain was termed PPV by Ota. Port-wine stain presents as part of Sturge-Weber syndrome (SWS). KTW presents with varicose veins and tissue hypertrophy alongwith port-wine stain. CASE DESCRIPTION: A 22-year-old male presented with decreased vision owing to high myopia and advanced glaucoma. Incidental findings noted were pigmentary naevi along with facial port-wine stain, which collectively comprises PPV. Also noted were bilateral varicose veins which are usually seen in association with KTW. In view of advanced visual field damage and inability to control intraocular pressures (IOP) on topical medications, he underwent Glaucoma filtration surgery in both eyes. Intra-operatively care was taken to avoid sudden decompression by controlled anterior chamber paracentesis, and scleral flap closure with releasable sutures was done to prevent hypotony related complications in the immediate postoperative period. Such precautions lead to an uneventful postoperative recovery, and even at 3 years' follow-up, the patient is maintaining IOP in early teens along with a stable visual acuity and visual fields. CONCLUSION: This case highlights the overlapping features of congenital conditions like oculodermal melanocystosis (ODM), SWS, KTW; presenting in a young male. Systemic features reported less frequently with PPV, included palatal pigmentation and palatal vascular malformations. CLINICAL SIGNIFICANCE: This case re-emphasizes a common origin of these entities, PPV and KTW, from the neural crest cells. Early recognition of the systemic features and timely surgical intervention under appropriate precautions, can be vision salvaging in such cases of developmental glaucoma.How to cite this article: Singh K, Dangda S, Mutreja A, Bhattacharyya M, Jaisingh K. Bilateral Phacomatosis Pigmentovascularis in a Young Male with Developmental Glaucoma and Varicose Veins. J Curr Glaucoma Pract 2018;12(2):94-98.

Simultaneous use of amniotic membrane and Mitomycin C in trabeculectomy for primary glaucoma.

PURPOSE: This study aimed to propose the role of amniotic membrane transplantation (AMT) as an additional modulator in primary Mitomycin C (MMC)-augmented trabeculectomy. METHODS: This was a randomized prospective interventional study. Forty eyes of 39 adult patients with uncontrolled primary glaucoma were randomly divided into two equal groups. Control group underwent trabeculectomy augmented with MMC while the study group underwent additional AMT. Patients were followed up for 12 months and outcomes measured were intraocular pressure (IOP), need for additional intervention, and bleb morphology. RESULTS: Complete success (defined as IOP <16 mmHg on no medication) could be achieved in 85% eyes in study group while it was 60% in control group (P = 0.04). IOP reduced by 71.1% in study group from 41.9 ± 10.6 to 12.1 ± 2.7 mmHg and from 40.5 ± 8.5 to 12.8 ± 4.5 mmHg in control group, a decline of 68.29%. Blebs in AMT group showed better bleb morphology in terms of significantly better extent (E3) on day 1 (P = 0.03) and better height (H2 and H3) (P = 0.04), according to the Indiana Bleb Appearance Grading Scale, at all follow-up visits along with normal vascularity. The study group required significantly lesser (P = 0.03) bleb needlings as compared to control group. CONCLUSION: Amnion enhanced the efficacy of MMC-modulated trabeculectomy in terms of eyes with complete success and lesser interventions such as bleb needling. This reiterates the role of amnion as a safe and effective bleb modulator. A diffusely elevated bleb with healthier conjunctiva can go a long way in predicting better health and longevity of the bleb.