Smartphone Color Vision Testing as an Alternative to the Conventional Ishihara Booklet.

Introduction Color vision testing was first seen as a parameter to be tested in the 1700s. Nowadays, it is a well-known phenomenon with significant quality-of-life implications. Structures involved in color vision include the lens, pupil, retinal cone photopigments, and several photoreceptor processes that translate the incoming spectrum of different light wavelengths into a processed colored image. An initial color vision assessment was made simply by comparing the color perception of the individual to that of the examiner. The most commonly used tools to screen for color vision defects today are color plates, such as the Ishihara color plates. In the modern age, smartphones have evolved to become an essential part of our everyday lives with applications such as Eye Handbook, which allow easier access to color vision testing using color plates displayed on smartphone screens. In this study, we compared color vision testing on Android and iOS devices to the standard Ishihara booklet. Materials and methods A cross-sectional validation study was performed on patients presenting to the Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan for six months. The sample size collected was 162 with a 95% confidence interval. The age range of the sample population was kept at 12-70 years. A patient was selected for participation in the study, and a color vision assessment was performed using the Ishihara color plates and Android and iOS smartphones. The collected data was then entered into IBM SPSS (Statistical Package for the Social Sciences) Statistics 25 for analysis, with the p-value being kept at 0.05. Results The sample size was 162, with the gender distribution being predominantly male (69.14%). The average age of the participants was 35.94 (SD = 12.04). The result of the two-tailed paired sample z-testwas not significant based on a p-value of 0.565, indicating the null hypothesis cannot be rejected. This finding suggests the difference between the mean of Ishihara and the mean of the iPhone was not significantly different from zero. Similar results were found for comparisons between Android smartphones and the Ishihara booklet. Conclusions Previous studies conducted showed nearly 60% of subjects with normal color vision correctly identified all colors on standard Ishihara color plates. The two-tailed paired sample t-test conducted in our study showed no significant difference between either of the smartphone groups (iPhone or Android) and the Ishihara booklet group, indicating that smartphones present a viable alternative to standard Ishihara booklet testing. However, there are certain limitations to our study. Different types of smartphone screens present a challenge in standardization while testing color vision, something that is not a problem when using the Ishihara booklet. However, smartphones are more widely available, more versatile, and present far greater ease of access. Both these factors should be considered when comparing the two in future studies.

Personal Computer-Based Visual Field Testing as an Alternative to Standard Automated Perimetry.

Introduction Standard automated perimetry (SAP) is the gold standard of visual field assessment in patients with neuro-ophthalmic conditions. Glaucoma is a progressive optic neuropathy characterized by damage to the ganglion cell complex with corresponding visual field defects and intraocular pressure (IOP) being the only modifiable ocular risk factor. Recent advances in technology have paved the way for remote screening and monitoring of visual field defects with the aid of a computer or tablet-based software. One such personal computer (PC)-based software is 'Specvis', which has shown promising reliability as compared to SAP. The primary objective of this study was to compare Specvis and Humphrey Field Analyzer (HFA) visual field reports in the graphical domain while secondary objectives were to estimate the ease of use of Specvis in comparison to HFA and comparison of test duration between Specvis and HFA.  Materials and methods This was a cross-sectional validation study performed at a tertiary care ophthalmology institute in Rawalpindi, Pakistan. Subjects presenting to the outpatient department were recruited based on consecutive sampling technique and were divided into healthy and diseased groups. Basic data collection instrument after informed consent was filled with demographic data, ophthalmic data, disease condition, and attached with analysis reports of both HFA and Specvis for assessment by three senior ophthalmology consultants independently. A total of 218 eyes of 109 subjects were included in this pilot study. SAP was done on the VF 30-2 program using HFA 3. The same patient then performed the visual field assessment on a PC with Specvis installed and settings adjusted to match the VF 30-2 program of HFA as closely as possible. Visual fields of a subject obtained from HFA and Specvis were then coupled and sent to three different senior ophthalmologists. The assessment was done by comparing the greyscale visual field printouts in the graphical domain and scored based on a 5-point Likert scale which were then analyzed for inter-observer reliability. After each test, all subjects were asked to rate the difficulty level of performing the test on HFA and Specvis based on a 5-point Likert scale. The duration of the test performed on HFA and Specvis was also noted for comparison. Results We observed male preponderance in our study participants (n=128, 58.72%). The majority of the participants were non-diseased (n=170, 77.98%) while advanced glaucoma was the commonest disease in the diseased group (n = 22, 10.09%). The mean age of the participants was 40.71 (SD=15.24). The observations for the HFA test duration had an average of 213.33 seconds (SD=33.49, Min=174.00, Max=314.00) while the Specvis test duration had an average of 267.36 seconds (SD=35.98, Min=228.00, Max=370.00). A significant positive correlation was observed between score 1, score 2, and score 3 given by the three ophthalmologists. A significant negative correlation was observed between ease of using HFA and age, with a correlation of -.28. A significant negative correlation was also observed between ease of using Specvis and age. Conclusion Specvis, a computer-based free open-source software used in our study, can give promising results in diagnosing as well as monitoring the progression of visual field defects. It can act as a significantly cost-effective and readily available bridge between visual field examination by confrontation method and SAP.

Worse Outcomes Associated With Liver Transplants: An Increasing Trend.

Background and aim Since individuals in the early stages of liver cirrhosis are typically asymptomatic, the prevalence of liver cirrhosis may be underestimated. Liver cirrhosis has a significant morbidity and mortality rate, with 1.03 million deaths worldwide each year. For end-stage liver disease, liver transplantation is a potential therapeutic option. The goal of our research was to examine the current trend in liver transplants using data from a national database. Methods Using the International Classification of Diseases (ICD)-9 codes, we identified individuals who had a liver transplant during the index hospital admission in the Nationwide Inpatient Sample from 2007 to 2011. This national sample of patients is from the United States. We looked at the yearly trend in liver transplants and related outcomes, such as duration of hospitalization (DOH), hospital expenses, and mortality in the hospital. In order to find determinants of mortality, we used a multivariate analysis. Results There were 25,331 patients hospitalized (weighted for national estimate). Between 2007 and 2011, the number of transplants grew by 1.2%. The majority of transplant recipients were Caucasian (57%), with an average age of 54 years, had a private healthcare plan (53%), and had average earnings in the upper quartile by zip code (26%). Patients with a higher Charlson Comorbidity Index (79% had a score of four) were more likely to be admitted to a southern hospital (33%), an academic hospital (>99%), and a large capacity hospital (90%). Seventy percent of liver transplant recipients received cadaver donors. Hepatitis C was the most prevalent reason for transplant (30%), followed by hepatocellular carcinoma (HCC) (29%) and alcoholic liver disease (25%). In 2011, compared to 2007, there was an upward rise in fatality (from 3.8% to 5.1%), average hospital expenditures (from $335,504 to $498,369), and DOH (from 17.4 to 22.7 days). The cost of hospitalization was two billion dollars per year. The independent variables related to an increased mortality on multivariate analysis were African American race (OR: 2.0, 95%, CI: 1.2-3.2; p=0.005) and large capacity hospitals (OR: 2.5, 95% CI: 1.6-4.1; p=0.0002). Predictors linked to lower mortality included private healthcare coverage (vs. Medicare: OR: 0.7, 95%, CI: 0.51-0.97; p=0.03), academic hospital (OR: 0.6, 95% CI: 0.4-0.8; p=0.005), cadaver donor (OR: 0.6, 95% CI: 0.5-0.8; p=0.002), HCC (OR: 0.6, 95% CI: 0.4-0.9; p=0.01), and non-alcoholic steatohepatitis (NASH) cirrhosis (OR: 0.4, 95% CI: 0.2-0.9; p=0.02). Conclusion Our study found an increasing trend in worse outcomes (increased mortality, average hospital costs, and average DOH) after a liver transplant. Patients of the African American race and large capacity hospitals were associated with a higher risk of death, whereas private healthcare plans, academic hospitals, cadaver donors, HCC, and NASH cirrhosis were associated with a lower risk.

Frequency of incidental ocular findings during pre-employment screening at a tertiary care Eye hospital.

OBJECTIVE: To highlight the prevalence of incidentally discovered ocular findings harvested amongst candidates of different age groups presented for pre-employment screening in a tertiary care eye hospital. METHODS: This Cross sectional prospective study was conducted in Armed Forces Institute of Ophthalmology, Rawalpindi, from Jun 2018 to Dec 2019. Data was collected using non-probability consecutive sampling technique. All candidates who appeared for medical fitness examination were included. Candidates belonged to various regions of Pakistan. Complete ophthalmic checkup including visual acuity, best corrected visual acuity, anterior and posterior segment examination was performed. The data analysis was done by IBM SPSS 2.0 software. RESULTS: One thousand and five hundred (1500) candidates underwent ophthalmic medical fitness examination during Jun 2018 to Dec 2019, out of these 86% (1290) were males and 14% (210) were females. Mean age of the candidates was 23.14 ± 5.66 years. The most common incidental ocular findings were amblyopia 24.6% (369), strabismus 10% (150), cataract 7.3% (110), macular scar 6.5% (100) and colour vision deficiencies 5.5% (82). CONCLUSION: The study demonstrates that out of total patients, 77% (1095) were found to be asymptomatic and 23% (405) were symptomatic. The study provides frequency for prevailing diseases and can help in improvement of eye care screening.

Topiramate-induced Acute Transient Myopia and Angle Narrowing.

Sulphamate drugs, widely prescribed for various systemic conditions, are reported to have rare ocular adverse-effects, usually within weeks of initiation of treatment. Medical and drug history in such cases are of pivotal importance in reaching a proper diagnosis. This study reports three cases, which developed topiramate-induced ocular side effects. In one of the cases, although the angles were narrow in both eyes, yet intra-ocular pressure (IOP) was not high. Also, in the third case, there were no macular striae. Topiramate was immediately withheld and all cases were improved without any permanent ocular damage. Key Words: Sulphamate, Topiramate, Angle closure glaucoma, Myopia.

Painless Posterior Scleritis: A Rare Presentation.

Posterior scleritis is an underdiagnosed condition due to its rarity and is frequently misdiagnosed due to its varied presentation.1 Therefore, it is imperative to know that it can present clinically as exudative retinal detachment, proptosis, disc oedema, choroidal folds, subretinal mass, and myositis. We report a case of 48-year female who presented with gradual, progressive loss of vision in left eye. There were multiple exudative retinal detachments with choroidal folds and disc oedema. Ultrasonography (USG) B scan and contrast enhanced magnetic resonance imaging (MRI) orbit revealed the classic T-sign. With oral steroids, she improved clinically. Posterior scleritis is a painful condition, but the patient did not report any pain in or around the globe, which makes this case a unique experience. Key Words: Posterior scleritis, Exudative retinal detachment, T-sign.